In out-of-hospital emergency medicine, pain in children is underestimated and undertreated. A reliable pain scale has not been validated till now in this setting. EVENDOL, is a AA single observational pain scale for all children younger than 8 years which has been validated in emergency pediatric units. The practicality of EVENDOL score in an out-of-hospital emergency setting has been explored in the study portrayed here.

This was an prospective multicenter study which comprised of all conscious children younger than 8 years. They were transported by a mobile intensive care unit between October 2008 and May 2010. The emergency physician and nurse independently estimated the child's pain. They used a numeric rating scale (score 0-10), then the 5-item EVENDOL scale (verbal/vocal expression, facial expression, movements, postures, and relationship with entourage) (score 0-3/item) at 3 time points (at rest, during examination, and after analgesia). The  internal validity, interrater reliability, discriminant ability (influence of fever and anxiety), and face validity of the scale was studied upon.

A total of 422 children participated in this study, out of which 82 and 62 (29%-39%) were in pain according to the emergency physician and nurses (numeric rating scale >3/10). For all population subsets, all EVENDOL scale attributes were fulfilled at all 3 time points. The values for the first estimation (entire study population) obtained were: internal validity (0.78-0.89), interrater reliability (r = 0.63-0.76, weighted κ = 0.49-0.65), construct validity, and discriminant ability (r = 0.6-0.7). No change was observed on the EVENDOL score due to fever. The anxiety level and pain were correlated. A fast (mean, 2.3-3.4 minutes) completion time and a good face validity was observed.

It was thus revealed that EVENDOL is a quick, easy-to-use, discriminant instrument to estimate pain in young children in out-of-hospital emergency settings.