# Assessment and Management of Pain and Fever in Pediatric Patients in the Emergency Setting: A Proposed Flowchart for the Triage Nurse

## TL;DR

This paper proposes flowcharts for emergency nurses to quickly assess and manage pain and fever in children using nurse-initiated medication.

## Contribution

The study introduces standardized protocols for triage nurses to administer analgesics and antipyretics in pediatric emergency care.

## Key findings

- Two protocols were developed for triage nurses to assess and manage pediatric pain and fever.
- Analgesics are administered for pain rated 4–6 without contraindications, and antipyretics for fever ≥37.5°C with discomfort signs.
- Patients receiving medication are reassessed after 1 hour with possible pediatrician evaluation.

## Abstract

Background: The nurse-initiated administration of medications, such as paracetamol and ibuprofen, at the time of triage may provide the opportunity to treat pediatric patients more quickly. We aimed to create practical flowcharts that can be used by all EDs with a specific focus on the nurse-initiated administration of medications to optimize the assessment and management of pain and fever in pediatric patients. Methods: Three regional expert meetings were held with a restricted working group composed of three chairmen and a wider working group composed of Directors of Pediatric EDs and Directors of Pediatric Departments, along with the main regional key experts for child healthcare management. Existing protocols were collected in the main centers belonging to the three regions and a unique recommendation was elaborated by the restricted group. This was then discussed and revised during discussion in a wider group. Results: Two protocols were developed for the triage nurse, one for pain and one for fever present. Both are initiated with assessment of the child’s pain or fever, followed by a caregiver interview to determine eligibility for the administration of an analgesic/antipyretic. In the case of pediatric pain, an analgesic is administered by the nurse only when the pain is rated as 4–6 and in the absence of specific contraindications. For pediatric fever, an antipyretic should only be administered if the child’s temperature is ≥37.5 °C and in the presence of at least 1 sign of discomfort. If an analgesic/antipyretic is administered, patients should be re-assessed after 1 h, and pediatrician evaluation requested as appropriate. Conclusions: The proposed flowcharts for pediatric pain and fever combine stratification by risk and severity and incorporate the possibility for the prompt administration of an antipyretic/analgesic when indicated.