Hierarchy of distressing procedures performed in two children's emergency departments

Abstract

Background: Procedures in emergency departments may cause pain and distress for children. In neonates procedural incidence has been well documented but there is scarcity of data in emergency departments.1 Medical and nursing perceptions of distressing procedures performed on children in emergency have been reported.2 We previously presented observer reported distress in procedures on children without sedation and ranked them in a distress hierarchy.3 Objectives: We elected to repeat the study in a second hospital confirm the previous findings and to improve numbers of the less frequent procedures. Method: Convenience sample of procedures performed over 10 week period in one children's emergency department in New Zealand and one in Australia. Ethics approvals at both sites with consent and assent when practicable. A trained independent observer assessed distress before, during, and 30 seconds after each procedure. Distress measured using a validated observational tool; the Face, Legs, Activity, Cry, Consolability scale (FLACC) scored from 0 to 10; and an observed Visual Analogue Scale (ObVAS) from 0 (no distress) to 100 (severe distress). Self-report scores were also collected where possible. Results: 257 procedures were observed (204 NZ; 53 Australia). Mean age 4.8 y (median 4), 127 male (49%). FLACC and ObVAS were low prior to and after procedure (FLACC 1 and 1.5; ObVAS 8 and 9.5 respectively). ObVAS scores and FLACC scores during each procedure were similar. Mean ObVAS scores with 95% confidence intervals are shown in the Table 1. Conclusion: Urinary catheter and nasogastric insertion were the most distressing procedures and statistically more distressing than intravenous cannula. Sedation for these procedures should be considered. Topical anaesthetic is not effective for heel prick samples and probably accounts for the statistically higher distress caused by micro-collect compared to intravenous cannula. Interventions and research to reduce distress during procedures on children in emergency departments should be targeted to the most distressing procedures. (Table Presented).L719921102015-09-08 <br />