Pediatria e Terapêutica
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Assessment of Pain in Children Hospitalized in the Emergency Department, Vietnam National Children’s Hospital

Vi Quang Do, Toan Ngoc Pham, Hong Thi Dinh, Xuan Thi Do, Hai Thanh Le, Oanh Thi Nguyen, Duy Ngoc Le, Vera Komisarjevsky and John Colin Partridge

Background: Assessment of pain in emergency settings can be difficult, particularly in young children. However, it is essential to the appropriate management and treatment in children. Objective: To assess pain levels in pediatric patients admitted to an emergency department using standardized pain assessment tools. Methods: Descriptive, cross-sectional study of 1840 children hospitalized in the Emergency and Poison Control Department of the Vietnam National Children’s Hospital in Hanoi, Vietnam from 12/2014 to 3/2015. On admission and again at 6 hours, nurses or physicians assessed pain levels using the Wong-Baker Faces scale for children < 3 years and the FLACC score for children >3 years of age. Time of first analgesic administration (paracetamol or opioids) and basic demographic data were prospectively recorded on standard datasheets. Results: We enrolled 1840 children (66% male, 34% female) during the 4 months study period. Of this total, 1221 (66.7%) were 1 months to 3 years in age. On admission, no pain was noted in 356 (19.3%), mild pain in 746 (40.5%), moderate pain in 681(37%), and severe pain in 42 (2.3%). On admission, the mean pain score was (2.92 ± 1.94 on admission. After 6 hours, 820 (44.6%) children were pain-free and 755 (41%) had mild pain, with mean pain scores of 1.59 ± 1.79. Analgesics were not administered to children with no pain; analgesics were administered to 3.8% and 26% of patients with moderate or severe pain, respectively. There was no difference in the pain level by age groups or gender. Only 2.3% patients received analgesics, all of these had moderate or severe pain scores. Conclusions: Pain scales are useful in stratifying pain in children so that analgesics can be appropriately administered to those with the most acute pain. Pain scores can guide emergency physicians to treat nonverbal patients most in need of analgesics.