Drendel Amy L, Brousseau David C, Gorelick Marc H
Department of Pediatric Emergency Medicine, Children's Hospital, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Pediatrics. 2006 May;117(5):1511-8. doi: 10.1542/peds.2005-2046.
To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.
A cross-sectional analysis was conducted of ED visits for pediatric patients from the National Hospital Ambulatory Medical Care Survey (1997-2000). Survey weighted regression first was used to assess the association between patient visit characteristics and pain score documentation. The regression then was repeated to determine the association between documentation of a pain score and analgesic use, adjusting for visit characteristics.
A total of 24,707 visits were included. Only 44.5% of visits had documented pain scores. In the regression analysis, younger age, self-pay, visits to pediatric facilities, and visits that were not designated as injury related were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid prescription. When no pain score was documented, the odds of receiving any analgesic was similar to visits with pain documented as mild.
ED pain score documentation is suboptimal in the pediatric population. Infants and toddlers are at particular risk for not having a pain score documented. There is a significant association between pain score documentation and the use of any analgesic, particularly opioids. Improvements in pain documentation for acutely ill and injured children are needed to improve pain management.
研究儿科患者在急诊科的就诊特征与疼痛评分记录之间的关系，并确定疼痛评分记录是否与镇痛药物使用增加有关。
对来自国家医院门诊医疗调查（1997 - 2000年）的儿科患者急诊科就诊情况进行横断面分析。首先使用调查加权回归来评估患者就诊特征与疼痛评分记录之间的关联。然后重复该回归分析，以确定疼痛评分记录与镇痛药物使用之间的关联，并对就诊特征进行调整。
共纳入24,707次就诊。只有44.5%的就诊记录了疼痛评分。在回归分析中，年龄较小、自费、到儿科医疗机构就诊以及非指定为与损伤相关的就诊与疼痛评分记录减少有关。疼痛评分记录与开具镇痛药物处方和阿片类药物处方的几率增加有关。当未记录疼痛评分时，接受任何镇痛药物的几率与记录为轻度疼痛的就诊相似。
儿科人群中急诊科疼痛评分记录情况欠佳。婴幼儿尤其有未记录疼痛评分的风险。疼痛评分记录与使用任何镇痛药物，特别是阿片类药物之间存在显著关联。需要改善急性病和受伤儿童的疼痛记录，以改善疼痛管理。
