Pain Management in the Emergency Department: Patterns of Analgesic Utilization

Petrack, Emory M.; Christopher, Norman C.; Kriwinsky, Jan

doi:10.1542/peds.99.5.711

Cited by 215 publications

(131 citation statements)

References 7 publications

(14 reference statements)

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“…Several studies have been published, however, that examine differences between pediatric and general emergency departments in the management of bronchiolitis and, as well, several other diseases. [47][48][49][50][51][52][53] Although several studies used surveys to assess opinions regarding various management strategies, [47][48][49] some also used a retrospective methodology to establish actual differences in practice patterns between pediatric and general emergency physicians. 50 -53 In general, retrospective studies are thought to provide poorer quality data than that obtained from a prospective study design.…”

Section: Discussionmentioning

confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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ABSTRACT. Objective. It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.Design. Retrospective cohort review of emergency department visits from April 1992 to March 1997.Setting. Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses ϳ850 000 people.Patients. All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).Main Outcome Measure. Population-standardized estimates of admission rates.Results. The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, populationstandardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.Conclusion. Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/e49; bronchiolitis, hospitalization rates, practice variation, emergency department. ABBREVIATIONS. CHR, Calgary Health Region; International Classification of Diseases, Ninth Revision; CI, confidence interval. B ronchiolitis is an extremely common childhood disease that accounts for a significant proportion of pediatric hospitalizations. 1 Investigators, using the technique of small-area analysis, have found marked variations in hospitalization rates of children with bronchiolitis with reports of up to sixfold differences in rates per 100 000 children. [2][3][4] This degree of variation is not unique to bronchiolitis, in that substantial variations in rates have been documented for a number of surgical procedures and diseases. 5,6 Although controversy exists as to which factors, in general, are most responsible for the variability in medical practices, in most cases differences in health care access and socioeconomic factors account for at least some proportion of the variability. 5,6 Likewise, in the case of b...

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Section: Discussionmentioning

confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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“…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%

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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“…12 Time to initial analgesia across a number of studies varies from 74-116 minutes, suggesting that there is significant room for improvement. [12][13][14][15] A limited number of American studies have assessed resident knowledge and pain management practices in non-ED settings. Anesthesia residents have been found to have a significantly better knowledge base regarding pediatric pain management when compared to pediatric or orthopedic residents.…”

Section: Introductionmentioning

confidence: 99%

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Ali

Kircher

Meyers

et al. 2015

CJEM

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Background: Under-treatment of children's pain in the emergency department (ED) can have many detrimental effects. Emergency medicine (EM) residents often manage pediatric pain, but their educational needs and perspectives have not been studied. Methods: A novel online survey was administered from May to June 2013 to 122 EM residents at three Canadian universities using a modified Dillman methodology. The survey instrument captured information on training received in pediatric acute pain management, approach to common painful presentations, level of comfort, perceived facilitators, and barriers and attitudes towards pediatric pain. Results: 56 residents participated (46%), 25 of whom (45%) indicated they had not received any training in pediatric pain assessment. All levels of residents reported they were uncomfortable with pain assessment in 0-2 year olds (p = 0.07); level of comfort with assessment increased with years of training for patients aged 2-12 years (p = 0.02). When assessing children with disabilities, 83% of respondents (45/54) indicated they were 'extremely' or 'somewhat' uncomfortable. Sixty-nine percent (38/55) had received training on how to treat pediatric pain. All residents reported they were more comfortable using pain medication for a 9 year old, as compared to a 1 year old (oral oxycodone p < 0.001, oral morphine p < 0.001, IV morphine p = 0.004). The preferred methods to learn about children's pain management were role-modeling (61%) and lectures (57%). The top challenges in pain management were with non-verbal, younger, or developmentally delayed patients. Conclusion: Canadian EM residents report receiving inadequate training in pediatric pain management, and are particularly uneasy with younger or developmentally disabled children. Post-graduate curricula should be adjusted to correct these self-identified weaknesses in children's pain management.

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Pain Management in the Emergency Department: Patterns of Analgesic Utilization

Abstract: ED analgesia continues to be used less frequently in the pediatric compared with the adult population. Inadequate dosing of discharge analgesic medication in children is a significant problem. Patterns of analgesic utilization may differ in different types of ED settings.

Cited by 215 publications

References 7 publications

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

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

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

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