Management of pain and anxiety in children in the emergency department.

INTRODUCTION

Injury-related pain and anxiety are common among children in the emergency department (ED) and often inadequately treated despite existing guidelines. This study aimed to assess the proportion of children who received adequate pain and anxiety relief in a Danish ED.

METHODS

We conducted a prospective study of 184 children (0-17 years) presenting with injuries at a level 1 trauma centre in Denmark (September-October 2025). Pain and anxiety were assessed during observation in the clinic using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale (≤ 5 years) and the Wong-Baker visual analogue scale (VAS) (> 5 years). Adequate relief was defined as a FLACC Scale score ≤ 3 or a Wong-Baker VAS in the 1-3 range. We collected data on treatments, non-pharmacological interventions, senior anaesthesiologist involvement, satisfaction and adverse effects during the visit and through follow-up calls.

RESULTS

In the study, 50% (92 children, 95% CI: 43-57%) received adequate pain and anxiety relief. Non-pharmacological interventions were rarely used (not used in 57% of children ≤ 5 years and in 97% of children > 5 years). Although a senior paediatric anaesthesiologist was always available for phone consultation, this was used in only 1.7% of cases (n = 3). Adverse effects of medication were observed in 16.2% of children during the ED visit (6/37 treated with medications).

CONCLUSIONS

Half of paediatric patients did not receive adequate pain and/or anxiety relief in the ED. Protocolled non-pharmacological strategies and consultations with the available senior anaesthesiologist were rarely used.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.