National Journal of Emergency Medicine SEMI

Register      Login

VOLUME 2 , ISSUE 1 ( January-April, 2024 ) > List of Articles

Original Article

Discerning Gradients of Paediatric Pain; Employing the Colour Analogue Scale (CAS) for Stratifying Degrees of Pain Severity in Juvenile Patients in Emergency Department

Ashwin Deepak, Rajadurai Meenakshisundaram, Salman Saeed, Hari Baskar, P Prabakaran, J Esther Monica, Athivaram Chaitanya Reddy, Nihas Babu, Anand Raj

Keywords : Colour analogue scale, Convenience sampling, Emergency department, Exclusion criteria, Paediatric pain perception

Citation Information : Deepak A, Meenakshisundaram R, Saeed S, Baskar H, Prabakaran P, Monica JE, Reddy AC, Babu N, Raj A. Discerning Gradients of Paediatric Pain; Employing the Colour Analogue Scale (CAS) for Stratifying Degrees of Pain Severity in Juvenile Patients in Emergency Department. 2024; 2 (1):11-14.

DOI: 10.5005/njem-11015-0034

License: CC BY-NC 4.0

Published Online: 26-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: This study endeavours to accurately gauge the spectrum of mild, moderate, and severe acute pain in the paediatric demographic by leveraging the colour analogue scale (CAS). The primary objectives encompass the meticulous quantification of pain gradients, delineating specific centimetre thresholds for each category. Through this, the research aims to augment precision in the realm of paediatric pain management practices. Materials and methods: This prospective study, utilising convenience sampling, focused on pain complaints in children aged 5–16 in the Emergency Department. Exclusions involved altered sensorium, clinical instability, intensive care unit (ICU) admission needs, or developmental delays. Participants used a standardised 10-cm CAS to mark and categorise their pain severity as ‘none’, ‘mild’, ‘moderate’, or ‘severe’. This approach aims to comprehensively understand paediatric pain in the Emergency Department. Results: In a cohort of 150 juveniles (mean age 10.51 years), gender distribution was balanced (48% males, 52% females). Trauma-related cases constituted 47%, with 63% falling into the low socio-economic category. Pain nature analysis revealed 47% soft painful conditions, 31% abdominal pain, and 21% headaches. Preliminary assessments showed 12% reporting no pain, 23.3% mild, 42.7% moderate, and 22% severe pain. Traumatic aetiology comprised 46.7%, primarily soft-tissue injuries. Numeric representations for pain scores were 0.56 cm (no pain), 2.03 cm (mild), 4.61 cm (moderate), and 7.62 cm (severe). Statistical analysis found no significant differences in age, gender, or aetiology concerning pain scores, but socio-economic status correlated significantly with CAS scores. A highly significant correlation was observed between pain type, pain score, and CAS score (correlation coefficient 0.903). Conclusion: This study delves into defining levels of mild, moderate, and severe pain on the CAS in paediatric cases. The insights gained provide a practical guide for promptly recognising children experiencing significant pain. The outlined scores also prove valuable for identifying eligible participants in analgesic studies. It's crucial to note the distinction in the perception of pain severity between adults, as documented in existing literature, and the nuanced paediatric perspective.


PDF Share
  1. IASP Terminology-IASP. Available online: http://www.iasp pain. org/Education/Content.aspx?ItemNumber=1698&navItem Number=576#Pain.
  2. Wier LM, Yu H, Owens PL, et al. Overview of Children in the Emergency Department, 2010: Statistical Brief #157. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs; 2013.
  3. Ortiz MI, López-Zarco M, Arreola-Bautista EJ. Procedural pain and anxiety in paediatric patients in a Mexican emergency department. J Adv Nurs 2012;68(12):2700-2709. DOI: 10.1111/j.1365-2648.2012.05969.x.
  4. McConahay T, Bryson M, Bulloch B. Defining mild, moderate, and severe pain by using the color analogue scale with children presenting to a pediatric emergency department. Acad Emerg Med 2006;13(3):341–344. DOI: 10.1197/j.aem.2005.09.010.
  5. Farrar JT, Young JP, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94(2):149–158. DOI: 10.1016/S0304-3959(01)00349-9.
  6. Hirschfeld G, Wager J, Schmidt P, et al. Minimally clinically significant differences for adolescents with chronic pain-variability of ROC-based cut points. J Pain 2014;15(1):32–39. DOI: 10.1016/j.jpain.2013. 09.006.
  7. Fortier MA, Anderson CT, Kain ZN. Ethnicity matters in the assessment and treatment of children's pain. Pediatrics 2009;124(1):378–380. DOI: 10.1542/peds.2008-3332.
  8. Bulloch B, Tenenbein M. Validation of 2 pain scales for use in the pediatric emergency department. Pediatrics 2002;110(3):e33. DOI: 10.1542/peds.110.3.e33.
  9. Hanley MA, Masedo A, Jensen MP, et al. Pain interference in persons with spinal cord injury: Classification of mild, moderate, and severe pain. J Pain 2006;7(2):129–133. DOI: 10.1016/j.jpain.2005.09.011.
  10. Krebs EE, Carey TS. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med 2007. DOI: 10.1007/s11606-007-0321-2.
  11. Thiadens T, Vervat E, Albertyn R, et al. Evaluation of pain incidence and pain management in a South African paediatric trauma unit. SAMJ: South African 2011;25;101(8):533–536. PMID: 21920126.
  12. Turk DC, Melzack R, (Eds). Handbook of Pain Assessment, 3rd edition. The Guilford Press; 2011.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.