Pain assessment practices in the pediatric intensive care unit

Abstract Purpose Pain assessment is the first step in managing pain; however, this can be challenging, particularly in settings such as the Pediatric Intensive Care Unit (PICU). This paper reports the current pain assessment practices from a study that was conducted describing the prevalence of pain, pain assessment, painful procedures, interventions, and characteristics of critically-ill children. Specifically, this paper addresses the child's communicative ability, pain scales, and characteristics of pain. Design and methods The primary study was a cross-sectional, multi-site, descriptive design. Data from a 24-hour time period were collected from medical records and bedside nurses. Results Data were collected from the records of 220 children across 15 PICUs. The average number of pain assessments per child was 11.5 (SD 5.8, range 1–28). Seven behavioral scales and five self-report scales were used. There were times when no scale was used, “assume pain present” was recorded, or a sedation scale was documented. Twelve pain scales, including the target population, scoring, psychometric properties, and clinical utility are described. Conclusions Results of this study indicate that a wide range of pain assessment tools are used, including behavioral scales for children unable to self-report. Implications Foremost, the appropriate assessment method needs to be chosen for each child to manage pain. Knowledge of the criteria for the use of each pain assessment scale will help the clinician select the appropriate scale to use for each child. The practice of “assume pain present,” as well as standardization of pain scales, and clinical support tools needs further investigation.