Epidemiology of paediatric pain-related visits to emergency departments in the USA: a cross-sectional study

Anderson, Jana L.; Silva, Lucas Oliveira J. e; Funni, Shealeigh A.; Bellolio, M. Fernanda; Jeffery, Molly Moore

doi:10.1136/bmjopen-2020-046497

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…Pain is a common complaint among pediatric patients presenting to the emergency department (ED). In 2017, 19.7 million pediatric visits to EDs in the US were related to pain [1]. Despite ongoing advocacy for pain assessment and management of children in the ED, there is still a major limitation in achieving these goals [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

Valani,

Kassam,

Jose

et al. 2023

PLoS ONE

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Background Pediatric patients with pain of various causes present to the emergency department. Appropriate assessment and management of pain are important aspects of emergency department treatment. However, only a few studies have identified the predictors of both outcomes. This study aimed to evaluate the rate of pain assessment at triage and subsequent management and to identify the predictors of each outcome. Methods This was a multi-center retrospective study based at five community emergency departments. Pediatric patients (< 18 years) with pain or injury who presented to the emergency department between February 2018 and May 2018 were included. In addition to patient demographics, the initial pain assessment at triage, reason for visit, and time to analgesia were determined. Further, the type and route of analgesia were identified in patients who received analgesia. Univariate and multivariable regression models were used to identify predictors of pain assessment and management. Results There were 4,128 patients with an average age of 9.6 years, and 49.1% of them were female. Only 74.2% of the patients underwent assessment for pain at triage, and 18.3% received analgesia. The median time to analgesia was 95 (IQR: 49–154) min. Most patients presented with head/neck (36.1%), upper limb (21.6%), and lower limb (19.9%) pain. The oral route was the most common analgesia delivery method (67.4%), and ibuprofen and acetaminophen were the primary agents used. Younger age, higher acuity, and presenting with head or neck pain were independent predictors of pain assessment at triage, while children 3–5 years and those with lower extremity pain were more likely to receive analgesia. Conclusion Although pain assessment at triage has improved in pediatric patients, there is still a major deficiency in adequate pain management. Our study highlights predictors of pain assessment and management that can be considered for improved pediatric care.

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Section: Introductionmentioning

confidence: 99%

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

Valani,

Kassam,

Jose

et al. 2023

PLoS ONE

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“…[8,9] While most pharmacological therapies studied are superior to placebo, [8] many patients report dissatisfaction with traditional treatment options and concerns related to efficacy and safety [10]. Increasingly, patients across the age spectrum are seeking alternative, more "natural," nonpharmacological options, with the medical community responding with increased interest in the potential benefits of food or food extracts on functional gastrointestinal disorders [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Eltorki

Leong

Ratcliffe

2022

Canadian Journal of Gastroenterology and Hepatology

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Introduction. This systematic review aimed to summarize evidence to determine the effectiveness of kiwifruit or kiwifruit extracts in the treatment of constipation. Methods. Electronic databases were searched from inception to May 2022 without any age or language limitations. Eligible studies enrolled participants with constipation who were randomized to receive kiwifruit or kiwifruit extracts vs. any nonkiwifruit control. Standardized mean difference (SMD) and mean difference (MD) with confidence intervals (CI) were determined for the following outcomes: frequency of spontaneous bowel movements (SBM), abdominal pain and straining, as well as stool type as determined by the Bristol Stool Scale (BSS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to rate the certainty of evidence. Our review was registered on PROSPERO (CRD42021239397). Results. Seven RCTs, including 399 participants (82% female; mean age: 42 years (SD 14.6)), were included. Compared with placebo (n = 95), kiwifruit extracts might increase the weekly frequency of SBM (MD: 1.36; 95% CI: −0.44, 3.16) with low certainty of evidence; moreover, it had an uncertain effect on BSS (SMD: 1.54; 95% CI: −1.33, 4.41) with very low certainty of evidence. Additionally, compared with placebo (n = 119), kiwifruit or its extracts reduced abdominal pain (SMD: −1.44, 95% CI −2.83, −1.66) with moderate certainty of the evidence and improved frequency of straining (SMD: −0.29; 95% CI: −1.03, 0.47). Compared with psyllium, kiwifruit may increase the weekly frequency of SBM (MD: 1.01; 95% CI: −0.02, 2.04) with moderate certainty evidence, and may increase the value on the BSS (indicating softer stools) (MD: 0.63; 95% CI: 0.01, 1.25)with low certainty of evidence. Compared to placebo, kiwifruit-encapsulated extracts may result in an increase in minor adverse events (relative risk: 4.58; 95% CI: 0.79, 26.4). Conclusions. Among individuals with constipation, there is an overall low certainty of evidence indicating that kiwifruit may increase SBM when compared to placebo or psyllium. Although overall results are promising, establishing the role of kiwifruit in constipation requires large, methodologically rigorous trials. Protocol Registration: PROSPERO registration number CRD42021239397.

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“…Approximately 57% of children have pain on arrival to the emergency department (ED). 1 Most children are discharged home with moderate or severe pain and require pain treatment. [2][3][4][5] Injuries (eg, fractures, sprains, strains, contusions) are the most common cause of ED visits by children in pain.…”

Section: Introductionmentioning

confidence: 99%

Video Education Intervention in the Emergency Department

Jacobson

Coleman

Weisman

et al. 2022

WestJEM

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Introduction: After discharge from the emergency department (ED), pain management challenges parents, who have been shown to undertreat their children’s pain. Our goal was to evaluate the effectiveness of a five-minute instructional video for parents on pain treatment in the home setting to address common misconceptions about home pediatric pain management. Methods: We conducted a randomized, single-blinded clinical trial of parents of children ages 1-18 years who presented with a painful condition, were evaluated, and were discharged home from a large, tertiary care pediatric ED. Parents were randomized to a pain management intervention video or an injury prevention control video. The primary outcome was the proportion of parents that gave their child pain medication at home after discharge. These data were recorded in a home pain diary and analyzed using the chi square test to determine significant difference. Parents’ knowledge about components of at-home pain treatment were tested before, immediately following, and two days after intervention. We used McNemar’s test statistic to compare incorrect pretest/correct post-test answers between intervention and control groups. Results: A total of 100 parents were enrolled: 59 parents watched the pain education video, and 41 the control video. Overall, 75% of parents completed follow-up, providing information about home medication use. Significantly more parents provided pain medication to their children after watching the educational video: 96% vs 80% (difference 16%; 95% CI 7.8-31.3%). Significantly more parents had correct pain treatment knowledge immediately following the educational video about pain scores (P = 0.04); the positive effects of analgesics (P <0.01); and pain medication misconceptions (P = 0.02). Most differences in knowledge remained two days after the video intervention. Conclusion: The five-minute educational video about home pain treatment viewed by parents in the ED prior to discharge significantly increased the proportion of children receiving pain medication at home as well as parents’ knowledge about at-home pain management.

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Epidemiology of paediatric pain-related visits to emergency departments in the USA: a cross-sectional study

Cited by 8 publications

References 16 publications

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis

Video Education Intervention in the Emergency Department

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