Frontiers in Emergency Medicine

The utilization of pain assessment tools in pediatric emergency for better pain management

Shafiqa M AL Sharif — 2025-04-29

Objective: Accurate assessment of acute pain in children is essential for effective emergency care but can be challenging due to varying pain expressions across ages. Our study aims to examine healthcare providers’ efforts to enhance assessment using age-appropriate tools. Methods: Patients were retrospectively selected from the King Abdulaziz University Hospital Emergency records which involved a cohort review of 157 children presented to the pediatric emergency department with acute pain from 2017 to 2018. Routine pain assessment tool grading acute pain as mild, moderate, severe by qualified pediatric emergency doctors, Canadian triage acuity scale (CTAS) and numerical rating scale (NRS) were used to describe pain intensity. Inter-statistical cohort analysis was used. Results: The mean age of patients were 8±3.3 years (range: 2.5-13.9 years) with 73 girls and 84 boys. About 80% (n=126) of the children presented to the emergency department with acute pain were scored as CTAS 2-3. All triaged patients passed to the emergency department were assessed as mild (n=66, 42%), moderate (n=27, 17%) and severe (n=35, 22%) pain. The NRS scoring was used in only 12 (7.6%) children as NRS only applies to older children. Paracetamol and nonsteroidal anti-inflammatory drug (NSAID) were the most frequent analgesia administered by the health care providers. There was a statistically insignificant relationship between the severity of the pain and the type of analgesia (P value>0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05) Conclusion: Pain assessment with scoring methods like CTAS or NRS in the emergency room (ER) is crucial despite challenges. Inconsistent use affects outcomes, emphasizing the need for research to encourage consistent application in pediatric emergency care.

Developing a model for predicting intra-abdominal injuries following blunt trauma; a cross-sectional study

Saeed Safari — 2025-05-05

Objective: Finding the associated factors of traumatic intra-abdominal injuries (IAIs) and designing a predictive model could minimize the unnecessary use of computed tomography (CT) scans. This study aimed to develop a risk stratification model in this regard. Methods: This prospective cross-sectional study was conducted at the emergency department (ED) of a level III trauma center. In this study, we thoroughly examined the association between demographic details, physical examinations, laboratory tests, and ultrasonography with abdominopelvic CT scan results regarding the presence of intra-abdominal injuries following blunt abdominal trauma, trying to develop a risk stratification model in this regard. Result: A total of 472 blunt trauma patients with a mean age of 39.06±18.49 (range: 15-96) were investigated (81.1% male). 47 intraabdominal damages in 45 (9.5%) patients were diagnosed. Based on logistic regression analysis, presence of abdominal pain (odds ratio [OR]: 39.60; 95% CI: 9.42,166.35), positive focused assessment sonography in trauma (FAST results (OR: 46.93; 95% CI: 14079,148.89), and injury severity index (ISS)≥25 (OR: 6.43; 95% CI: 2.07,19.90) were significantly correlated with the presence of intraabdominal injuries in blunt trauma patients. The area under the ROC curve of the model was 0,865 (95% Cl: 0.805,0.926) with 86.67% sensitivity and 86.41% specificity. Conclusion: Being accurate and user-friendly alongside broader criteria compared to similar studies makes our risk stratification model a reliable decision-making tool to optimize CT scan usage in the emergency department.

Comparison of trauma severity in and out of the navigation ring around the metropolis: a case of Tabriz, Iran

Abazar Fathollahzadeh — 2025-05-06

Objective: One of the causes of severe injuries in urban accidents is the occurrence of accidents on urban highways and city outskirts. The present study will determine the severity of accidents in the complete urban ring of Tabriz, including Shahid Kasaei highway, Pasdaran, Dizel Abad, Sento road, and Airport road in Tabriz during the years 2016-2022. Methods: In a cross-sectional descriptive study, the injuries from traffic accidents that were registered in the pre-hospital emergency center of Tabriz city were included. The study variables included all the information recorded in the pre-hospital emergency file between 2016 and 2022 and included 44,712 injured patients. Timing of the missions, variables related to the injured (demographics, vital signs), the accident's location, the injury's severity, and the accident's outcome were evaluated at the scene. Data were analyzed by SPSS 24 software. Results: Among 44,712 patients, 32,299 (72.2%) were men and the rest were women. Regarding the location of the accident, 34321 (76.8%) of the injured were inside the city, and 10391 (23.2%) had an accident in the city traffic ring. The most common accident site was in the traffic ring on Pasdaran highway, with 3179 injured (30.6%). The rate of on-scene death was higher in traffic accidents inside the traffic ring (1.3% vs. 0.9%). The severity of trauma was higher inside the traffic ring (P-value ˂0.001). Reaction and response time were higher in missions outside the traffic ring, leading to death at the scene (P value˂0.001). Conclusion: Based on the study results and the role of arrival time on the outcome of missions, it seems necessary to establish new pre-hospital emergency stations inside the city. It is necessary to pay more attention to education through the media and improve the general culture of society to reduce the accidents and injuries caused by it.