497 - Pediatric Self-Reported Pain Outcomes following Emergency Department Discharge: How Do They Compare to Parents’ Perceptions?

The opioid epidemic and a paucity of evidence on at-home acute pain experiences have resulted in inconsistent recommendations for treatment of fracture pain following emergency department (ED) discharge. A methodologic barrier to understanding the child’s pain and function following ED discharge is parent’s report of their child’s patient reported outcomes.

Objective:

Determine the feasibility of children self-reporting pain experiences by texting. Response rate and agreement between the child and parent proxy report of their daily experiences were evaluated.

Design/Methods:

Prospective analysis of child-parent dyads from the PECARN IMPROVE study discharged home after ED treatment for a bone fracture. Daily texts were sent to parents and children for 7 days, including these outcomes: maximum daily pain (0-10), Parents’ Post-operative Pain Measure-Short Form (PPPM-SF) (validated measure of pain/function, 0-10), and medication dissatisfaction (1-4). Descriptive analyses, t-tests, weighted Kappa coefficients, and linear models adjusting for survey day and correlations between respondents evaluated differences in outcomes between dyads.

Results:

80 child-parent dyads were included. Children were 19% female, median age was 13 years. (range 8-17). 54% were White, 9% Black, 10% Hispanic.

Children responded by text a median of 6 days (IQR 2.0-7.0), similar to parent response frequency with a median of 6 days (IQR 3.0-7.0). Overall, 80% of children reported on at least 1 day, 74% for 3 or more days, and 45% for 7 days. Children answered all 10 PPPM-SF questions on fewer days than parents (means= 4.22 vs 4.96, difference = 0.74 less (95% CI: 0.16, 1.31; p=0.006).

Weighted kappa statistic for agreement between the child and parent’s outcome report was low to moderate ranging from 0.11 – 0.60 across the 3 outcomes. On average, children reported somewhat less favorable outcomes on any given day than their parents reported for them, as indicated by higher maximum pain scores (difference=0.31, 95% CI: 0.09, 0.52; p=0.006), similar PPPM-SF scores (difference=0.21, 95% CI: -0.03, 0.44; p=0.086), and higher dissatisfaction scores (difference=0.22, 95% CI: 0.15, 0.30; p< .001).

Conclusion(s): Children as young as 8-17 years old can feasibly self-report patient outcomes by text message, with similar frequency of any daily text engagement but lower rates of answering all PPPM-SF items. Children report higher pain severity and dissatisfaction with pain medications than parents. These outcome differences should be explored as they may impact study findings that utilize parent proxy report.