Pediatric Pain Assessment in the Emergency Department

Phase 1 is a qualitative assessment of how pain is currently evaluated in the pediatric ED.
Initial triage encounters will be observed and audio recorded. In addition to determining
how often the Wong Baker FACES Pain Rating Scale (WBF) is administered with the intended
script, the investigators will determine if there are common variations from the recommended
script. The investigators will also evaluate how often a caregiver's perception of the
child's pain is considered when completing the WBF.

Phase 2 is a quantitative assessment to determine if neurocognitive development impacts the
responsivity of the WBF and the Faces Pain Scale - Revised (FPS-R) as well as the cognitive
age equivalent required to use these scales accurately. Patients presenting with acute pain
will report their level of pain before and after analgesic intervention using both the WBF
and the FPS-R. They will also subjectively report their change in pain following analgesic
intervention. Once the patient's pain has improved, he/she will complete the BRIGANCE Early
Childhood Screens III to determine his/her cognitive age equivalent. He/she will also
complete a series of tasks aimed to assess ability to successfully use the WBF and FPS-R
(matching, grouping, classification, and seriation skills). The results of the child's
self-report of pain will also be compared to the caregiver's estimate of the child's pain.

Inclusion Criteria:

- verbal patients

- pain score ≥ 6/10

- caregiver speaks English or Spanish

Exclusion Criteria:

- altered mental status

- history of traumatic brain injury (TBI)

- history of developmental delay

- history of Autism

- history of chronic pain, defined as persistent or recurrent pain in children with
chronic health conditions

- non-verbal patients