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Procedural pain and anxiety in paediatric patients in a Mexican emergency department


  • Mario I. Ortiz,

    1. Mario I. Ortiz MSc MD PhD, Professor, Área Académica de Medicina del Instituto de Ciencias de la Salud de la Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico, and, Hospital del Niño DIF, Pachuca, Hidalgo, Mexico
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  • Mayeli López-Zarco,

    1. Mayeli López-Zarco RN, Paediatric Nurse, Hospital del Niño DIF, Pachuca, Hidalgo, Mexico
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  • Edna J. Arreola-Bautista

    1. Edna J. Arreola-Bautista MD, Paediatric Physician, Hospital del Niño DIF, Pachuca, Hidalgo, Mexico
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M.I. Ortiz: e-mail:


Aim.  This article is a report of a study carried out to investigate the procedures that are likely to induce pain and anxiety in children in a Mexican emergency department.

Background.  In emergency rooms, children often experience unpredictable diagnostic and therapeutic procedural-related pain that can be associated with considerable anxiety.

Design.  A prospective, descriptive and cross sectional study was conducted to investigate the prevalence of procedures or situations that probably induced anxiety and/or pain in children in an emergency room.

Methods.  Procedural pain and anxiety were evaluated in children and adolescents (8–16 years) who were admitted to the emergency department of a paediatric hospital between February–September 2010. Children rated their pain and anxiety using a 100-mm visual analogue scale.

Results.  A total of 252 children with a mean age of 10·1 years were evaluated. Four-hundred fifty-nine procedures were completed, with an average of 1·82 events/child. Of these procedures, 369 (80·4%) were rated painful and 357 (77·8%) were rated stressful. The most frequently reported procedural pain or stressful episodes were peripheral catheterization, clinical examination and vascular puncture. Overall, 32·5% of the painful events were rated severe, 32·0% were rated moderate and 35·5% were rated slight. However, 30% of the stressful events were rated severe, 38·9% were rated moderate and 31·1% were rated slight. Peripheral catheterization was rated severe in 58 children (33·9%), moderate in 55 children (32·2%) and slight in 58 (33·9%) children.

Conclusion.  This study provides data on common emergency department procedures that cause pain and anxiety in children and young adolescents. Healthcare providers must consider the best psychological and pharmacological interventions to reduce procedural anxiety and pain.

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