Abstract
BackgroundPediatric pain is associated to patient weight and demographics in specialized settings, but pain prevalence and its associated patient attributes in general pediatric outpatient care are unknown. Our objective was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters.MethodsCross-sectional observational study of 26,180 patients ages 2 to 19 seen in five urban pediatric primary care clinics between 2009 and 2016. Data were collected from systematic screening using a computerized clinical decision support system. Multivariable logistic regressions were used to analyze the association between pain reporting and obesity (body mass index), age, sex, race, season, insurance status, clinic site, prior pain reporting, pain reporting method, and exam findings.ResultsPain was reported by the patient or caregiver in 14.9% of visits. In adjusted models, pain reporting was associated with obesity (Odds Ratio (OR) 1.23, 95% Confidence Intervals (CI) 1.11–1.35) and severe obesity (OR 1.32, CI 1.17–1.49); adolescents (OR 1.47, CI 1.33–1.61); and females (OR 1.21, CI 1.12–1.29). Pain reported at the preceding visit increased odds of pain reporting 2.67 times (CI 2.42–2.95). Abnormal abdominal, extremity, ear, nose, throat, and lymph node exams were associated with pain reporting. Pain reporting increased in minority races within clinics that predominantly saw a concordant race.ConclusionsPain is common in general pediatric encounters, and occurs more frequently in obese children and those who previously reported pain. Pain reporting may be influenced by seasonal variation and clinic factors. Future pediatric pain screening may be guided by associated risk factors to improve identification and targeted healthcare interventions.
Highlights
Pediatric pain is associated to patient weight and demographics in specialized settings, but pain prevalence and its associated patient attributes in general pediatric outpatient care are unknown
[30] We show that obesity and severe obesity were associated with higher pain report prevalence in a pediatric population visiting a general outpatient clinic
Using a large diverse sample, we establish the first data on prevalence of pain and associated characteristics in general pediatric primary care
Summary
Pediatric pain is associated to patient weight and demographics in specialized settings, but pain prevalence and its associated patient attributes in general pediatric outpatient care are unknown. Our objective was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters. Despite over 16 years of Joint Commission standards to assess and address patient pain, data are sparse regarding the prevalence, demographics, and body metrics associated with pain in general pediatrics. Prior studies have assessed pain in general practice or family practice, Grout et al BMC Pediatrics (2018) 18:363 the school, [11] national, [12] or international [13] levels. Even less is known of how clinicians respond to pain reports among children and physical exam findings from visits where pain is reported
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