• J O'Donnell, L P Ferguson, and T F Beattie.
• Accident & Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
• Eur J Emerg Med. 2002 Mar 1;9(1):5-8.

AbstractThe objective of this study was to assess analgesic use and the use of a pain scoring system on those children presenting to a paediatric accident and emergency (A&E) department with a history of injury due to trauma. A random sample of patients who presented to a paediatric A&E department over a 6-week period with a history of limb trauma were prospectively studied. Pain severity scores were assessed on arrival and at 10, 30 and 60 minutes using the Douhit Faces Scale and any analgesia given or plaster application was noted. One hundred and seventy-two patients were studied. The median age was 10 years (range 3-13 years) and the majority, 56%, were male. The mean initial pain scores were 2.7 (range 1-4) for boys and 3.0 (range 1-4) for girls. The presenting injuries were 103 upper or lower limb fractures and 69 'soft tissue' injuries. Only 84 (49%) patients received analgesic medication in the department (30% morphine; 70% paracetamol); analgesia was not given to the remaining 88 (51%). Of these, 7 declined analgesia, and 5 had already taken analgesia on arrival to A&E. Despite prompt triage (median time 2 minutes, range 0-10 minutes), the median time from arrival to paracetamol administration was 20 minutes (range 4-105 minutes) and for morphine was 14 minutes (range 2-57 minutes). Pain is a common symptom in patients presenting to A&E. Because children's pain can be particularly difficult to assess, a pain scoring system such as the Douhit Faces Scale can be a useful means of pain assessment in the A&E setting. Despite increased awareness, pain is still under treated in the A&E department.

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