P2.162: Pain Score Discordance Amongst Pediatric Patients, Parents, and EMS Providers

Background: A large number (42%) of patients transported via Emergency Medical Services (EMS) report acute pain; 64% of these citing intense pain. Most studies exploring pain in pediatric patients have investigated treatment effectiveness, accurate dosing, and EMS personnel attitudes and beliefs around pain management. As assessment of pain may also be a barrier to appropriate pain management by EMS clinicians, we sought to compare child pain self-rating and parent and EMS clinician estimation of patient pain.

Methods: Patients aged 0-17 years who were transported by EMS to an emergency department (ED) at a free-standing children’s hospital were prospectively enrolled. Pain scales (FLACC, FACES and numeric) were completed based on patient age within five minutes of arrival. Simultaneously, the patient’s parent, if present during the transport, and EMS clinician estimated the patient’s pain. The intraclass correlation coefficient (ICC) was used to assess agreement between the raters. Raters were assigned as over estimators (O; +2), under estimators (U; -2), or accurate (A; -1 to +1) to the patient score. Chi-square and one-way ANOVA were used to explore correlations between predictor variables and pain rating agreement.

Results: We recruited 250 children and each EMS clinician; 114 parents were included. Table 1 captures the descriptive statistics of the cohort. ICC comparing EMS clinician to patient pain rating was 0.426 (p < 0.001), indicating low agreement. Patient and parent pain rating were slightly higher in agreement with an ICC of 0.429 (p < 0.001). Nearly half (49.6%) of EMS clinicians were accurate in their rating, 18.0% overestimated patient pain, and 32.4% underestimated. Some (45.6%) parents were accurate, 36.8% overestimated patient pain, and 17.5% underestimated. No demographic factors (age, sex, race, ethnicity, language, insurance, length of stay, or ESI) were associated with EMS clinician or parent being in one of the three rater groups (O, U, or A; Table 2). Most (54.1%) EMS clinicians reported that, if the parent was present during the transport, they communicated about the patient’s pain. Caregivers were asked about how well the patient’s pain was managed during the transport. Most caregivers (64.9%) felt that the patient’s pain was adequately managed by scoring this question between eight and ten.

Conclusion: We found a low agreement between child pain self-rating and EMS clinician and parent observed pain. EMS clinicians more frequently underestimated patient pain, while parents more frequently overestimated child pain. Assuming self-reported pain is the gold standard, our findings suggest that additional education is needed for EMS clinicians to better assess child pain while in transport to the hospital.