Pain management of acute appendicitis in Canadian pediatric emergency departments

Abstract

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.

Publication status of completed registered studies in paediatric appendicitis: a cross-sectional analysis

“… 11 12 Optimisation of pain management in children with appendicitis has recently become the centre of several investigations. 13 14 …”

Effect of patient and nurse ethnicity on emergency department analgesia for children with appendicitis in israeli government hospitals

“…Less than half of the children with appendicitis in our ED cohort received analgesia (any 32.1%, opioid 7.8%). This rate of analgesia administration is markedly lower than those reported in recent US and Canadian studies (any 56.8%, opioid 41.3%; and, any 61%, 42.8% opioid, respectively) (Goyal et al., ; Robb et al., ). Our low rate of analgesia administration, including opioids, is disappointing in light of the 2010 Israel Medical Association recommendations regarding analgesia for children with acute abdominal pain (Shavit et al., ).…”

Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department

“…Acute abdominal pain is a frequent cause of paediatric emergency department visits and, even though prompt pharmacological analgesia is strongly recommended, children with acute abdominal pain are still often undertreated . Paediatric studies focusing on analgesia in children with acute abdominal pain have only investigated the usefulness of major opioids such as morphine and oxycodone .…”

“…Paediatric studies focusing on analgesia in children with acute abdominal pain have only investigated the usefulness of major opioids such as morphine and oxycodone . Even though in clinical practice NSAIDs and paracetamol are frequently prescribed for children with acute abdominal pain , to the best of our knowledge, this was the first trial to investigate the usefulness of an NSAID, paracetamol and an opioid such as tramadol, in this setting. Previous experiences with adult patients showed that intravenous tramadol and paracetamol were equally effective in reducing acute abdominal pain, without influencing examination findings .…”