Addressing the Differences by Race in Analgesia Use among Pediatric Patients Attending Emergency Departments

Elder, Keith; Rice, Stephen K.; Dean, Caress; Piper, Crystal N.

doi:10.1016/j.jpeds.2014.06.046

Cited by 2 publications

(2 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,12 Although several advances have been made in improving pediatric pain management, 13 timely management of acute pain in children continues to be suboptimal in both prehospital and PED. [14][15][16] The difficulty of assessing pain in young children, the unfamiliarity of medical staff with new products and techniques, fear of adverse medication effects, staffing limitations, and time constraints 17,18 are the significant barriers to adequate pain management in PEDs. Additionally, some healthcare providers still have been believing that neonates and infants feel less pain than adults, making their pain management ineffectively.…”

Section: Introductionmentioning

confidence: 99%

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

Aleysae

2019

Emerg Care J

View full text Add to dashboard Cite

In recent years, the nasal route has increasingly been viewed as an alternative option for the delivery of analgesia, especially when the traditional ways are complicated or time-intensive. However, little is known about the value of this intervention in acute pain management in pediatric emergency medicine. This evidence-based analysis review aims to assess the current evidence regarding the use, safety, and effectiveness of intranasal analgesics in acutely painful conditions encountered in Pediatric Emergency Departments (PEDs). A systemic electronic searching of Cochrane library, PubMed, and EMBASE databases from the beginning of each database until October 2018 was conducted using a maximally sensitive searching strategy. Only randomized controlled trials (RCTs) or quasirandomized controlled trials that evaluated the use of intranasal analgesia for acute pain in children in the Emergency Department and published between January 1990 and October 2018 were included. The methodological quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Risks of bias within each included study were evaluated according to the Cochrane Risk of Bias Tool for RCTs. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. Seven RCTs and one quasi-randomized study met the inclusion criteria. Five studies compared an intranasal analgesic and an alternative intervention, two compared intranasal fentanyl against ketamine, and one compared two different concentrations of intranasal fentanyl. All included trials reported reductions in pain scores, especially within the first 10 to 30 minutes post-intervention; however, pain reduction was maintained to 60 minutes in only one study. No evidence of significant adverse events was associated with the administration of any intranasal analgesic in any of the included studies. This review identified eight articles that discussed the intranasal analgesia as a possible route of analgesia in the PED. While no paper was entirely perfect, the findings support the idea that intranasal analgesia may be an effective analgesic for the treatment of children (3-18 years) with acute moderate to severe pain, and its administration appears to cause minimal adverse effects.

show abstract

Section: Introductionmentioning

confidence: 99%

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

Aleysae

2019

Emerg Care J

View full text Add to dashboard Cite

show abstract

“…Differences in opioid prescribing by patient race and socioeconomic status have been reported for a variety of diagnoses among adult and pediatric patients in emergency department and ambulatory care settings with a majority of studies finding non-white patients and uninsured patients less likely to receive opioids [ 18 – 25 ]. Studies of hospitalized pediatric patients have reported that opioid exposure prevalence was higher for females, older children, and white children [ 21 , 22 , 26 , 27 ]. Others have also identified significant institutional variation in the prevalence and length of opioid use [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia

et al. 2018

View full text Add to dashboard Cite

PurposeA cohort of pediatric patients with AML treated at hospitals contributing to the Pediatric Health Information System was used to evaluate differences in opioid utilization by sex, age, race, and insurance.MethodsBilling data were used to compute the prevalence of opioid exposure and to quantify rates of utilization among those exposed to opioids as days of use per 1000 inpatient days. Multivariable regressions were used to compare opioid prevalence, and rates of utilization among those exposed.ResultsOn average across courses, 95.2% of patients were exposed to analgesics, 84.7% were exposed to non-opioid analgesics and 77.7% were exposed to opioids. The proportion of opioid-exposed patients increased with age, but did not differ by gender, race, or insurance status. Analyses limited to patients exposed to opioids revealed modest differences in days of opioid use among female patients (adjusted rate ratio (aRR) = 1.19, 95% CI: 1.11, 1.28), patients <1 year (aRR = 1.37, 95% CI: 1.21, 1.55) or ≥10 years of age (aRR = 1.63, 95% CI: 1.46, 1.82), whereas Asian patients received fewer days of opioids compared with white patients (aRR = 0.76, 95% CI: 0.61, 0.95). There was moderate hospital-level variability in both the prevalence of opioid utilization overall and preference for specific opioid medications. There was greater inconsistency in practice concerning choices for supplemental and alternative opioids than in first-line opioid utilization.ConclusionAdditional work is needed to discern whether observed differences in opioid utilization by age and race reflect a difference in treatment or a difference in the experience of pain. Future studies should also explore the factors which guide decisions on opioid selections in an attempt to explain the variability across institutions.

show abstract

Addressing the Differences by Race in Analgesia Use among Pediatric Patients Attending Emergency Departments

Cited by 2 publications

References 28 publications

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia

Contact Info

Product

Resources

About