Observational pain assessment versus self-report in paediatric triage

Objective: To examine if observational pain assessment can be used for purposes of triage in children aged >3 years. Methods: A prospective, single blind, controlled trial was undertaken in children who presented to the emergency department (ED) with pain. Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score (AHTPS), an observational tool designed for triage, and a self-report tool, either the Wong-Baker Faces Pain Rating Scale (WBS) for 3–7-year-old children or a visual analogue scale (VAS) for 8–15-year-old children. Scores were compared by instrument (observational and self-report) and ED location (waiting room and triage room). Results: 75 children (29 aged 3–7 years and 46 aged 8–15 years) were enrolled in the study. The AHTPS scores were significantly lower than the scores measured by the WBS/VAS (p<0.001). The level of pain measured by both methods (self-report, observational) was lower in the triage room. Compared with the AHTPS, the WBS and VAS scored significantly lower in the triage room than in the waiting room (p<0.042 and p<0.006, respectively). Conclusions: Observational pain assessment underestimates children’s perception of pain and should not be recommended in children aged >3 years. Triage has a calming effect on children.