Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Abstract

Objectives: Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Methods: Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Results: Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Conclusions: Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts. RÉSUMÉObjectifs: D'après des données, il y a une sous-utilisation, un report de l'administration et un dosage insuffisant de l'analgésie dans les services des urgences (SU) chez les patients souffrant de douleurs abdominales aiguës. En ce qui concerne les médecins qui pratiquent dans les services des urgences pédiatriques (SUP) au Canada, les auteurs ont : 1) examiné les différences de pratique théorique dans l'administration de l'analgésie chez les enfants souffrant de douleurs abdominales aiguës; 2) cerné les motifs à l'appui du report de l'administration de l'analgésie; et 3) évalué le lien entre l'administration de l'analgésie et les consultations en chirurgie.

Pain management of acute appendicitis in Canadian pediatric emergency departments

“…6,12,16 Interestingly, a recent survey of Canadian physicians, including those trained in pediatric emergency, pediatrics, emergency, and family medicine, demonstrated substantially higher self-reported rates of analgesic provision in pediatric appendicitis as compared to our findings. 20 In a case of suspected appendicitis, 92.1% of survey respondents reported that they would offer immediate analgesia. Fifty-eight percent reported that they would offer an IV opioid analgesic.…”

“…Fifty-eight percent reported that they would offer an IV opioid analgesic. 20 This may reflect social desirability bias due to self-reporting, 21 or patient refusal of analgesia. The discrepancy between self-reported rates of analgesia provision and the directly observed rates of analgesia provision suggest that providers are likely aware of the need to provide analgesia.…”

“…Furthermore, current practice patterns are inconsistent with guidelines for the management of appendicitis-related pain children in timing, dosage, and choice of analgesic agent, despite selfreported provider knowledge of the necessity of analgesia. 10,15,20 Multidimensional strategies to narrow the knowledge to practice gap in analgesia provision for pediatric appendicitis, including triage-initiated protocols for analgesia and practice guidelines for health care providers, may help address this issue.…”

Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

“…Although this has not been explored to date, current evidence suggests that caregivers harbour concerns surrounding harm, 13 as well as the addictive potential 11,14 of analgesics. In addition, a discrepancy exists between survey data on the high clinicianreported use of analgesia 15,16 and institutional audits of practice patterns that suggest otherwise. 17,18 If the refusal of analgesia were identified as a barrier to adequate pain management for children, it would provide a compelling rationale for the development of educational strategies directed at dispelling misconceptions and encouraging acceptance of analgesia offered in the ED.…”

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

“…Acute abdominal pain is a common cause of suffering and discomfort for children in the pediatric emergency department (ED) (Fein et al, 2012). Numerous studies have shown that children with acute abdominal pain are undertreated for pain in the ED (Kim et al, 2003;Goldman et al, 2008;Poonai et al, 2016). Acute appendicitis is the most common surgical cause of acute abdominal pain in the pediatric ED; and, administering analgesia has been shown to not impede the diagnosis of appendicitis nor increase the incidence of appendicitis-related complications (Kim et al, 2002;Bailey et al, 2007;Furyk and Sumner, 2008;Poonai et al, 2014).…”