Assessment and management of pain in children in A&E: are we doing it the right way?

Introduction

Pain management is one of the most important components in patient care. The severity of the pain should be assessed effectively and weight-based analgesia should be given. The BAEM Clinical Effectiveness Committee standard of analgesia for moderate and severe pain within 20 minutes of arrival in A&E should be applied to children in all A&E Departments

Methods

A retrospective study. Five casualty cards with soft tissue injury and fractures in children under 16 years old were picked randomly every day from January 2005. The assessment and management of pain was recorded in each case. A validated pain score tool – Alder Hey triage pain score – was introduced April 2005. Five casualty cards were picked randomly every day from May 2005. The assessment and management of pain in each case was recorded.

Results

There were 155 patients in each month. In January, none of the patients were assessed for the severity of their pain; 34 patients received analgesia, of which 15 received weight-based and 19 received age-based analgesia. In May, 84 patients were assessed for the severity of their pain with the Alder Hey triage pain score; 63 received weight-based and two received age-based analgesia. The rest had no pain.

Conclusion

The Alder Hey triage pain score should be introduced in A&E as it serves as an effective means of assessing pain in children of all age groups. Analgesia should be prescribed based on the weight of the children.