Are We Adequately Treating Pain in Children Who Present to US Emergency Departments?

Yackey, Katelyn; Rominger, Annie

doi:10.1097/pec.0000000000000750

Cited by 8 publications

(15 citation statements)

References 14 publications

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“…In previous studies, the analgesic provision rate in the paediatric ED was 52.8% to 69.3% in the United States [3,11] but only 13.8% to 26.8% in South Korea [12,13]. In our study, before the introduction of the Pain Passport, 24.1% of children received analgesics, which is suboptimal by CEM standards of 50% within 20 minutes of arrival [14].…”

Section: Discussionmentioning

confidence: 52%

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

et al. 2020

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Background: In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods: This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results: A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions: Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

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Section: Discussionmentioning

confidence: 52%

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

et al. 2020

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“…Rates of opioid administration have been shown to be consistently lower for children compared with adults suffering from conditions ranging from long-bone fractures to acute appendicitis. [9][10][11]45 However, the oligoanalgesia phenomenon has not generally been considered to be more prominent in…”

Section: Discussionmentioning

confidence: 99%

“…This definition is similar to that of previous studies of pediatric and general EDs in which NHAMCS data were used. 11,34 Covariates of interest included age category (0-6, 7-12, 13-17, and 18-25 years), mode of arrival (eg, ambulance), reported pain severity, expected payer source, and race and/or ethnicity.…”

Section: Methodsmentioning

confidence: 99%

“…[2][3][4][5][6][7] At that time, emergency departments (EDs) were specifically cited for undertreating children with a variety of painful conditions. [8][9][10][11][12] Subsequently, pediatric and adolescent patients have experienced dramatic increases in exposure to and harms from prescription opioids. 13,14 Across the United States, the death rate from opioid overdose among individuals ages 15 to 24 years old has risen to 8.6 per 100 000, making death from opioid overdose more common than death from malignancy, congenital disorders, and heart disease combined.…”

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confidence: 99%

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Prescription Opioid Use in General and Pediatric Emergency Departments

2019

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BACKGROUND AND OBJECTIVES: Recent evidence reveals that exposure to emergency department (ED) opioids is associated with a higher risk of misuse. Pediatric EDs are generally thought to provide the highest-quality care for young persons, but most children are treated in general EDs. We sought to determine if ED opioid administration and prescribing vary between pediatric and general EDs. METHODS: We analyzed the National Hospital Ambulatory Medical Care Survey (2006-2015), a representative survey of ED visits, by using multivariate logistic regressions. Outcomes of interest were the proportion of patients #25 years of age who (1) were administered an opioid in the ED, (2) were given a prescription for an opioid, or (3) were given a prescription for a nonopioid analgesic. The key predictor variable was ED type. A secondary analysis was conducted on the subpopulation of patients with a diagnosis of fracture or dislocation. RESULTS: Of patients #25 years of age, 91.1% were treated in general EDs. The odds of being administered an opioid in the ED were similar in pediatric versus general EDs (adjusted odds ratio [OR] 0.88; 95% confidence interval [CI] 0.61-1.27; P = .49). Patients seen in pediatric EDs were less likely to receive an outpatient prescription for opioids (adjusted OR 0.38; 95% CI 0.27-0.52; P , .01) than similar patients in general EDs. This was true for the fracture subset as well (adjusted OR 0.27; 95% CI 0.13-0.54; P , .01). CONCLUSIONS: Although children, adolescents, and young adults had similar odds of being administered opioids while in the ED, they were much less likely to receive an opioid prescription from a pediatric ED compared with a general ED.

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“…Despite the increasing weight of evidence that infants' and children's experience of pain has a negative impact on short-term and long-term outcomes, 1-4 pain continues to be poorly managed, particularly in infants and children presenting to emergency departments (EDs). [5][6][7][8][9][10][11][12] Reasons cited for the suboptimal treatment of pain and distress in EDs include among other factors, poor recognition of significant pain by medical providers. 13 The generally accepted standard for pain assessment is self-report.…”

Section: Introductionmentioning

confidence: 99%

Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months

et al. 2017

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IntroductionInfants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal or postoperative pain. What is not well understood is how well these scales perform when used to assess procedural pain in infants and children.AimThe aim of this study was to test the psychometric and practical properties of the Face, Legs, Activity, Cry and Consolability (FLACC) scale, the Modified Behavioural Pain Scale (MBPS) and the Visual Analogue Scale (VAS) observer pain scale to quantify procedural pain intensity in infants and children aged from 6–42 months to determine their suitability for clinical and research purposes.Methods and analysisA prospective observational non-interventional study conducted at a single centre. The psychometric and practical performance of the FLACC scale, MBPS and the VAS observer pain scale and VAS observer distress scale used to assess children experiencing procedural pain will be assessed. Infants and young children aged 6–42 months undergoing one of four painful and/or distressing procedures were recruited and the procedure digitally video recorded. Clinicians and psychologists will be recruited to independently apply the scales to these video recordings to establish intrarater and inter-rater reliability, convergent validity responsiveness and specificity. Pain score distributions will be presented descriptively; reliability will be assessed using the intraclass correlation coefficient and Bland-Altman plots. Spearman correlations will be used to assess convergence and linear mixed modelling to explore the responsiveness of the scales to pain and their capacity to distinguish between pain and distress.Ethics and disseminationEthical approval was provided by the Royal Children’s Hospital Human Research Ethics Committee, approval number 35220B. The findings of this study will be disseminated via peer-reviewed journals and presented at international conferences.

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Are We Adequately Treating Pain in Children Who Present to US Emergency Departments?

Cited by 8 publications

References 14 publications

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

Prescription Opioid Use in General and Pediatric Emergency Departments

Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months

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