Pain Assessment for Pediatric Patients in the Emergency Department

Drendel, Amy L.; Brousseau, David C.; Gorelick, Marc H.

doi:10.1542/peds.2005-2046

Cited by 121 publications

(80 citation statements)

References 20 publications

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“…1,2,15 It is important that emergency health care providers caring for children recognize and treat pain appropriately. 4,10,15 To our knowledge, this is the first Canadian study to describe PEM physicians' approaches to pain management in pediatric ED settings.…”

Section: Discussionmentioning

confidence: 98%

“…Previous studies have demonstrated suboptimal pain measurement and documentation; Drendel and colleagues showed that attending a pediatric-specific ED was associated with lower rates of pain documentation compared to general EDs. 4 Corwin and colleagues have demonstrated that when a comprehensive pain screening, assessment, and management policy is implemented in a pediatric ED, there are significant improvements in the rates of analgesic administered, frequency of pain reassessment, and management of procedural pain. 14 In Canadian pediatric EDs, more widespread use of policies and procedures to identify, document, and treat pain may improve provision of analgesia in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 Children are at especially high risk for experiencing pain during their visit and frequently receive inadequate analgesia. [4][5][6][7][8][9][10] Inadequate management of children's pain can be attributed to multiple factors, including fear of adverse reactions, difficulty in the recognition of pain, fear of dependency, fear of overprescribing, and the misperception that neonates and young children do not experience pain as intensely as adults.…”

Section: Ré Sumémentioning

confidence: 99%

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Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉObjectifs: L'é tude visait à dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et à examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi à repé rer les sujets é ventuels, et une version modifié e de la Dillman's Total Design Survey Method a é té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse à l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins é taient â gé s de 31 à 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingtquatre pour cent des mé decins ont fait é tat d'une documentation obligatoire sur l'é valuation de la douleur dans leur é tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) é taient souvent prescr...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

See 1 more Smart Citation

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

View full text Add to dashboard Cite

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“…5,[9][10][11][12][13][14][15][16] Pediatric residents have also self-identified their lack of knowledge in pain and symptom management, 17 and pediatric attending physicians have rated the need for resident training for pediatric pain, pain assessment, and pharmacology of analgesics as moderate to high. 18 To further evaluate this perceived educational need, we recently developed and preliminarily validated a resident PPM knowledge assessment in a multiple-choice test format.…”

Section: Introductionmentioning

confidence: 99%

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

Saroyan¹,

Schechter²,

Tresgallo³

et al. 2010

Journal of Graduate Medical Education

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There are unique concerns for residents and fellows treating hospitalized children in pain. Some children cannot necessarily communicate their pain, 1,2 and the dosages for children differ dramatically by age and weight.3 Finally, because of a fear of adverse effects, the undertreatment of pain (ie, giving too little medicine) has been reported. 4,5 Lapses in the treatment of children's pain have been attributed, in part, to the following: systematic and logistical barriers within institutions providing pediatric care, 6 knowledge-based barriers including insufficient knowledge of pain assessment and treatment in children, 7 and inadequate pediatric pain management (PPM) educational requirements for residency programs.8 These inadequacies have also been shown to be widespread across a variety of pediatric settings such as cardiac surgery, AbstractBackground There are well-established deficiencies in residents' knowledge of acute-pain assessment and treatment in hospitalized children.

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“…By surveying 24,707 visits to the ED with painful conditions in a period of three years, only 44.5% of visits had documented pain scores with subsequent analysis showing the younger age to be the most vulnerable group. 15 …”

mentioning

confidence: 99%

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

Motov

Khan

2008

JPR

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Pain is the most common reason people visit emergency rooms. Pain does not discriminate on the basis of gender, race or age. The state of pain management in the emergency department (ED) is disturbing. ED physicians often do not provide adequate analgesia to their patients, do not meet patients' expectations in treating their pain, and struggle to change their practice regarding analgesia. A review of multiple publications has identifi ed the following causes of poor management of painful conditions in the ED: failure to acknowledge pain, failure to assess initial pain, failure to have pain management guidelines in ED, failure to document pain and to assess treatment adequacy, and failure to meet patient's expectations. The barriers that preclude emergency physicians from proper pain management include ethnic and racial bias, gender bias, age bias, inadequate knowledge and formal training in acute pain management, opiophobia, the ED, and the ED culture. ED physicians must realize that pain is a true emergency and treat it as such.

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Pain Assessment for Pediatric Patients in the Emergency Department

Cited by 121 publications

References 20 publications

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

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