Objective

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.

Study design

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.

Results

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).

Conclusions

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.

中文翻译：

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急性疼痛儿童自我报告疼痛评分的临床解读

客观的

确定最能代表儿童无痛、轻度、中度和重度疼痛类别的自我报告疼痛评分，以及准确代表儿童感知的药物需求的疼痛评分，即儿童能够达到的最低疼痛评分想要止痛药。

学习规划

前瞻性横断面队列研究，对象为 6-17 岁因疼痛和非疼痛情况就诊于儿科急诊科的儿童。使用 10 点口头数字评定量表测量疼痛。基于接受者操作特征的方法用于确定最能区分无痛与轻度疼痛、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。描述性统计用于确定对药物的感知需求。

结果

我们分析了 548 名儿童的数据（51.3% 为女性，61.9% 患有疼痛）。最能代表疼痛强度类别的分数如下： 0-1 表示无疼痛；2-5 轻度疼痛；6-7 为中度疼痛；8-10 表示剧烈疼痛。区分每个类别的切割点的曲线下面积范围为 0.76 至 0.88。代表感知药物需求的中位疼痛评分为 6（IQR，4-7；范围，0-10）。

结论

我们确定了与不同于常规使用的评分的疼痛强度类别相关的儿童人口水平自我报告的疼痛评分。实施我们的研究结果可以更准确地表示疼痛评分的临床意义，并减少研究中的选择偏差。我们的研究结果不支持单独使用疼痛评分进行临床决策，也不支持使用疼痛评分阈值来表示儿童对药物的感知需求。