Clinical Interpretation of Self-Reported Pain Scores in Children with Acute Pain.

Abstract

OBJECTIVES\nTo identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child s perceived need for medication (PNM), i.e. a minimum pain score at which a child would want an analgesic.\n\n\nSTUDY DESIGN\nProspective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and non-painful conditions. Pain was measured using the Verbal Numerical Rating Scale. Receiver operating characteristic-based methodology was used to determine pain scores that best differentiated no pain from mild, mild from moderate, and moderate from severe pain. Descriptive statistics were used to determine the PNM.\n\n\nRESULTS\nWe analyzed data from 548 children (51.3% female, 61.9% painful conditions). The scores that best represent categories of pain intensity are: 0-1 (no pain), 2-5 (mild), 6-7 (moderate), and 8-10 (severe) out of 10. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing PNM was 6 (IQR 4, 7; range 0-10) out of 10.\n\n\nCONCLUSIONS\nWe identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from those conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or use of a pain score threshold to represent a child s PNM.