Use color-coded scale to assess children's pain
Use color-coded scale to assess children's pain
A color-coded scale is effective at pain assessment in pediatric patients, says a new study that looked at 126 children between 5 and 12 years old presenting to a pediatric ED with acute pain.1
The Colored Analog Scale (CAS) is shaped like a thermometer, with color that gradually gets darker red as you go up the scale. Children are asked to slide a marker to show how much pain they are feeling, with corresponding pain ratings marked on the back of the scale. [Click here for Scale.]
When children marked their pain severity on the CAS before and after a pain intervention, 28 children described their pain as "the same," 58 said it was a "little less," and 29 said it was "much less." A previous study showed that the CAS was effective at defining mild, moderate, and severe pain.2
"Pain assessment and pain management of children in the emergency department has been underutilized and poorly addressed for many years," says Thomas E. McConahay, MD, the study's lead author and an ED physician at Phoenix Children's Hospital. It only is recently that the American Academy of Pediatrics, the American College of Emergency Physicians, and The Joint Commission have taken steps to correct this problem, he says.
ED nurses need to assess pain as a routine practice, using accurate tools, says McConahay. "Emergency nurses play a key role in this, as they are often the first to recognize pain in children during triage," he adds. "They also have extensive interaction with patients for reassessment of pain response."
The CAS is a relatively new method of pain scoring and is used fairly infrequently, but children ages 5 and older can comprehend it very well, he says. "This can be an invaluable tool in addressing pain and its management in children in the ED," McConahay says. "It allows quick, quantitative assessment of pain by staff, while being easy to understand by children. It also allows for evaluating the success of the implemented pain intervention," he explains.
Pinpoint location of pain
ED nurses need to have a variety of pain assessment tools at their disposal, to individualize care and use the one most appropriate for each patient, says Angela Just, RN, an ED nurse at Phoenix Children's Hospital.
The pain scale Just uses most often is the Wong-Baker Faces scale, which allows children to point to the face, ranging from smiling to crying, which correlates with the amount of pain he or she is experiencing. "Assessing pain in pediatric patients can be difficult, especially in younger children who are unable to verbalize pain," she says. Nonverbal signs of pain include crying, elevation in heart rate, blood pressure, respiratory rate, and diaphoresis, Just adds.
"Some children will be quiet, stoic, or even lethargic in response to pain," she says. Parents also can provide important information by telling the provider what unique expressions of pain the child has displayed in the past, Just adds.
To determine the exact location of the child's pain, make your patient as comfortable as possible before an examination, she suggests. Just recommends giving a pacifier or bottle to infants and allowing the parent to hold them, or having a child sit on a parent's lap and using toys or books as distractions. "During the physical exam, the child will likely cry or express pain when a painful area is palpated," she says. "Ask the child to point to what hurts or 'the owie,' either on himself or a stuffed animal."
References
- McConahay T, Bryson M, Bulloch B. Clinically significant changes in acute pain in a pediatric ED using the Color Analog Scale. Am J Emerg Med 2007; 25:739-742.
- McConahay T, Bryson M, Bulloch B. Defining mild, moderate, and severe pain by using the color analog scale with children presenting to a pediatric emergency department. Acad Emerg Med 2006; 13:341-344.
Sources
For more information on pediatric pain assessment, contact:
- Angela Just, RN, Emergency Department, Phoenix Children's Hospital. E-mail: [email protected].
- Thomas E. McConahay, MD, Department of Emergency Medicine, Phoenix Children's Hospital. Phone: (602) 546-1910. Fax: (602) 546-1907. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.