Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

Poonai, Naveen; Brzozowski, Victoria; Stang, Antonia; Drendel, Amy L.; Boisclair, Philippe; Miller, Michael R.; Harman, Stuart; Ali, Samina

doi:10.1017/cem.2018.382

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Second, we achieved an analyzable response rate of 46%, which could have been improved by avoiding summer months for release date of the survey and delivering more than 2 recall e-mails 10 . Similar surveys of Canadian emergency physicians obtained response rates ranging between 14% and 67% 20–22 . Lastly, because our sampling frame consisted of PERC members, a network of Canadian health care professionals engaged in pediatric emergency medicine research, participants to our study are more likely to be aware of the recent CPCA guidelines than the general ED physician population and, therefore, could have increased the proportion of physicians choosing not to obtain an ECG for typical vasovagal syncope.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiogram in Pediatric Syncope

Manouzi¹,

Sanatani

Doan³

2021

Pediatr Emer Care

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Objectives: We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population.Methods: We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG. Results:The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope.Conclusions: This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.

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Section: Discussionmentioning

confidence: 99%

Electrocardiogram in Pediatric Syncope

Manouzi¹,

Sanatani

Doan³

2021

Pediatr Emer Care

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“…Historically, pain management in neonates was given little attention, but it is clear both that neonates feel pain and that improper pain management and even prior painful procedures have potential long-term consequences for the patient. [82][83][84][85][86] Multiple options exist for non-opioid pain management of neonates during potentially painful procedures. In addition to local anesthesia, oral sucrose as well as skin-to-skin care have shown evidence of a reduction in pain.…”

Section: Neonatesmentioning

confidence: 99%

“…Neonates represent a particularly important population that often has painful procedures performed as a result of evaluations for infection and other medical needs. Historically, pain management in neonates was given little attention, but it is clear both that neonates feel pain and that improper pain management and even prior painful procedures have potential long‐term consequences for the patient 82–86 . Multiple options exist for non‐opioid pain management of neonates during potentially painful procedures.…”

Section: Introductionmentioning

confidence: 99%

Managing acute pain in children presenting to the emergency department without opioids

et al. 2022

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Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non‐pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.

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“…A recent prospective observational study evidenced that interspinous space, spinal canal depth, and subarachnoid space width present not significant difference in a seated or lateral position, as well as the trend to choose a more caudal point of puncture by less experienced physicians. [55][56][57]…”

Section: Lumbar Puncturementioning

confidence: 99%

Management of Neurological Emergencies in Children: An Updated Overview

Mastrangelo

Baglioni

2021

Neuropediatrics

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Neurological emergencies account for about one-third of the highest severity codes attributed in emergency pediatric departments. About 75% of children with acute neurological symptoms presents with seizures, headache, or other paroxysmal events. Life-threatening conditions involve a minor proportion of patients (e.g., less than 15% of children with headache and less than 5% of children with febrile seizures). This review highlights updated insights about clinical features, diagnostic workup, and therapeutic management of pediatric neurological emergencies. Particularly, details will be provided about the most recent insights about headache, febrile seizures, status epilepticus, altered levels of consciousness, acute motor impairment, acute movement disorders, and functional disorders, as well as the role of diagnostic tools (e.g., neuroimaging, lumbar puncture, and electroencephalography), in the emergency setting. Moreover, the impact of the current novel coronavirus disease2019 (COVID-19) pandemic on the evaluation of pediatric neurologic emergencies will also be analyzed.

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Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

Cited by 5 publications

References 27 publications

Electrocardiogram in Pediatric Syncope

Electrocardiogram in Pediatric Syncope

Managing acute pain in children presenting to the emergency department without opioids

Management of Neurological Emergencies in Children: An Updated Overview

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