Analgesia Administration for Acute Abdominal Pain in the Pediatric Emergency Department

Goldman, Ran D.; Crum, Dana; Bromberg, Rudy; Rogovik, Alex L.; Langer, Jacob C.

doi:10.1097/01.pec.0000195761.97199.37

Cited by 31 publications

(28 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, underdosing of morphine demonstrated in previous literature persisted in our findings. 6,12,16 Interestingly, a recent survey of Canadian physicians, including those trained in pediatric emergency, pediatrics, emergency, and family medicine, demonstrated substantially higher self-reported rates of analgesic provision in pediatric appendicitis as compared to our findings. 20 In a case of suspected appendicitis, 92.1% of survey respondents reported that they would offer immediate analgesia.…”

Section: Discussioncontrasting

confidence: 55%

“…13 Still, practice continues to be suboptimal, given that less than half of all children received an IV opioid. 12,16,17 In our study, IV morphine was provided significantly less frequently to school-aged children as compared to preschool or adolescent. This is in contrast to earlier literature, where younger children have been shown to receive less analgesia for painful conditions.…”

Section: Discussionmentioning

confidence: 52%

“…[11][12][13] The reasons for this are multifactorial and include age-dependent clinical presentation, difficulty in assessing pain in children, lack of comfort in using opioids in children, time constraints in busy acute care settings, and unwarranted concerns of obscuring the signs and symptoms of a surgical abdomen. 10 A review of current practice patterns regarding pain management may encourage and form a basis for focused knowledge translation strategies to support optimal analgesic use for suspected appendicitis in children.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pain management of acute appendicitis in Canadian pediatric emergency departments

Robb

Ali

Poonai

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). Methods: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision. Results: A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years.

show abstract

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain management of acute appendicitis in Canadian pediatric emergency departments

Robb

Ali

Poonai

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…Goldman and colleagues described this phenomenon, whereby morphine was given more commonly to children with a higher probability of appendicitis. 4 Similarly, a significant number of respondents indicated they would provide immediate oral analgesia to patients who were vomiting or due for surgical consultation. This may reflect a reluctance to provide intravenous opioids as a first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that analgesia is underutilized for acute abdominal pain [1][2][3][4][5] , delayed in its administration, [1][2][3] and dosed insufficiently 1,3 in the emergency department (ED) setting. Compared to adults, children are at particular risk for suboptimal analgesia and have been found to receive analgesia less often.…”

Section: Introductionmentioning

confidence: 99%

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Poonai

Cowie

Davidson

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Methods: Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Results: Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Conclusions: Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts. RÉSUMÉObjectifs: D'après des données, il y a une sous-utilisation, un report de l'administration et un dosage insuffisant de l'analgésie dans les services des urgences (SU) chez les patients souffrant de douleurs abdominales aiguës. En ce qui concerne les médecins qui pratiquent dans les services des urgences pédiatriques (SUP) au Canada, les auteurs ont : 1) examiné les différences de pratique théorique dans l'administration de l'analgésie chez les enfants souffrant de douleurs abdominales aiguës; 2) cerné les motifs à l'appui du report de l'administration de l'analgésie; et 3) évalué le lien entre l'administration de l'analgésie et les consultations en chirurgie.

show abstract

Opiates and Acute Abdominal Pain

Radzik¹,

Bua²,

Marchetti³

2007

JAMA

View full text Add to dashboard Cite

Analgesia Administration for Acute Abdominal Pain in the Pediatric Emergency Department

Abstract: Children with abdominal pain receive more analgesia when the physician suspects appendicitis, yet only in half of the cases, and only 15% receive opioids. Opioid underdosing happens in a quarter of times it is given.

Cited by 31 publications

References 13 publications

Pain management of acute appendicitis in Canadian pediatric emergency departments

Pain management of acute appendicitis in Canadian pediatric emergency departments

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Opiates and Acute Abdominal Pain

Contact Info

Product

Resources

About