Abstract
Pain is a common presenting complaint in pediatric emergency departments (EDs). In 2001 the Joint Commission for Healthcare Organizations (JCAHO) set standards for pain assessment and management that have become important quality indicators. These Joint Commission standards led EDs to treat pain as a “fifth vital sign” to be measured and addressed. JCAHO left the details of pain assessment metrics to the facilities, thus no single scale has been recommended as the standard of care in pediatrics. Self-reported pain severity scales are considered ideal, but young and cognitively impaired children are unable to effectively use these tools. Other observational scales have been developed to reliably measure pain in these populations. Debate about the value of pain metrics persists in the medical literature despite the near-universal institutionalization of pain measurement in US EDs.
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