Improving the Pediatric Procedural Experience: An Analysis of Pain, Anxiety, and Satisfaction

OBJECTIVE: The purpose of this investigation was to compare self-reported and perceived pain and anxiety among patients, caregivers, and providers before, during, and after common emergency department (ED) procedures while evaluating the impact of commonly used adjuncts on overall satisfaction. METHODS: A prospective observational study of children undergoing painful procedures in an ED was conducted from January 2015 to March 2017. Before, during, and after the procedure, patients older than 3 years of age rated their pain and anxiety. At the same time points, the provider and caregiver rated their impression of the patient’s pain, and the caregiver also rated the patient’s anxiety. After the procedure, satisfaction was elicited from the caregiver and the provider. RESULTS: A total of 257 children were enrolled: 150 for intravenous line placement, 53 for wound repair, and 44 for a variety of other procedures. Caregivers rated pain higher than providers before, during, and after the procedure (P values <0.001, <0.001, and 0.003, respectively). Caregivers rated anxiety higher than patients before, during and after the procedure (P values <0.001, 0.03, and 0.002, respectively). Providers were less satisfied with the 1- to 2-year age-group compared to the 8+ years age groups (P values 0.01 and 0.002). CONCLUSIONS: Caregiver perception of pain and anxiety of the patient exceeds provider and sometimes patient reports. The youngest children present a challenge for caregivers and providers and have lower satisfaction compared to older groups.