Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Faculty of Business, CareTech OWL Center for Health, Welfare and Technology, Bielefeld University of Applied Sciences, Bielefeld, Germany.
J Pediatr. 2022 Jan;240:192-198.e2. doi: 10.1016/j.jpeds.2021.08.071. Epub 2021 Aug 31.
To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic.
Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication.
We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10).
We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.
确定能最好地代表儿童无疼痛、轻度、中度和重度疼痛类别的自报疼痛评分，以及能准确代表儿童对药物治疗需求的疼痛评分，即儿童希望使用止痛剂的最小疼痛评分。
这是一项针对 6-17 岁儿童的前瞻性横断面队列研究，这些儿童因疼痛和非疼痛病症就诊于儿科急诊室。使用 10 分制数字评分量表来测量疼痛。采用基于受试者工作特征曲线的方法来确定能最好地区分无疼痛与轻度疼痛、轻度疼痛与中度疼痛以及中度疼痛与重度疼痛的疼痛评分。采用描述性统计来确定对药物治疗的需求。
我们分析了 548 名儿童（51.3%为女性，61.9%有疼痛症状）的数据。能最好地代表疼痛强度类别的评分如下：0-1 分表示无疼痛；2-5 分表示轻度疼痛；6-7 分表示中度疼痛；8-10 分表示重度疼痛。区分各疼痛类别的截断点的曲线下面积范围为 0.76-0.88。表示对药物治疗需求的疼痛评分中位数为 6（四分位距，4-7；范围，0-10）。
我们确定了与疼痛强度类别相关的儿童人群自报疼痛评分，这些评分与传统使用的评分不同。实施我们的发现可能会更准确地反映疼痛评分的临床意义，并减少研究中的选择偏倚。我们的发现不支持将疼痛评分单独用于临床决策，也不支持使用疼痛评分阈值来表示儿童对药物治疗的需求。
