Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

Falch, Claudius; Vicente, Diego; Häberle, Helene; Kirschniak, Andreas; Müller, S.; Nissan, Aviram; Brücher, Björn L.D.M.

doi:10.1002/j.1532-2149.2014.00456.x

Cited by 57 publications

(42 citation statements)

References 78 publications

(105 reference statements)

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“…A recent literature review in adults highlighted a lack of therapeutic consensus and an ongoing practice pattern that favors withholding analgesia prior to surgical evaluation. 11 Another recent study of children with appendicitis revealed that almost 60% did not receive analgesia. 12 Significant delays in time to analgesia have also been identified.…”

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confidence: 99%

“…16,17 A recent retrospective chart review revealed that significantly fewer children with appendicitis are provided with analgesia compared to adults. 11 Suboptimal analgesia for abdominal pain appears to persist in children as evidenced a Canadian survey, which reported that only half of children being investigated for appendicitis received analgesia in the ED. 17 The highest rate of analgesia administration reported for acute abdominal pain in a pediatric ED setting was in Australia and New Zealand and only reached 62%.…”

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confidence: 99%

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Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

Poonai

Paskar

Konrad

et al. 2014

Academic Emergency Medicine

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Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.Methods: Trials were identified through electronic searches of MEDLINE (1946MEDLINE ( -2013, EMBASE (1980EMBASE ( -2013, Cochrane Central Register of Controlled Trials (2013), CINAHL (1981CINAHL ( -2013, and Google Scholar (2013). All randomized controlled trials (RCTs) of children aged 0-18 years with acute abdominal pain that compared any opioid analgesic to placebo were included. The methodologic qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively.Results: Six RCTs met inclusion criteria, and each compared a single-dose parenteral opioid to a placebo, providing data on 342 children aged 5 to 18 years. The pooled mean pre/post difference in selfreported pain scores was 19.61 mm (95% confidence interval [CI] = -1.16 to 40.37 mm) lower in those receiving opioid analgesia. There was no significant increase in the risk of perforation or abscess associated with opioids in cases of appendicitis (relative risk [RR] = 1.03, 95% CI = 0.55 to 1.93). The risk of side effects was significantly greater in patients who received opioids (RR = 6.06, 95% CI = 1.10 to 33.49). Subtherapeutic dosing of opioids was detected in all six trials. Conclusions:The use of opioids in undifferentiated acute abdominal pain in children is associated with no difference in pain scores and an increased risk of mild side effects. However, there is no increased risk of perforation or abscess. The overall quality of evidence is low, suggesting the need for larger, high-quality trials that are powered to detect both serious complications of appendicitis and determine the most efficacious opioid dosing for children.ACADEMIC EMERGENCY MEDICINE 2014;21:1183-1192© 2014 3 Historically, the reluctance among clinicians to provide analgesia to patients with acute abdominal pain 4-6 was thought to be due to concerns of obscuring the diagnosis of appendicitis and delayed management. 7,8 Indeed, pediatric emergentologists have identified disapproval by their surgical colleagues as a barrier to providing analgesia.6 Despite a decade of evidence that opioid analgesia is not associated with an increased risk of diagnostic or management errors, 9,10 this phenomenon continues to be reported. A recent literature review in adults highlighted a lack of therapeutic consensus and an ongoing practice pattern that favors withholding analgesia prior to surgical evaluation.11 Another recent study of children with...

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confidence: 99%

mentioning

confidence: 99%

Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

Poonai

Paskar

Konrad

et al. 2014

Academic Emergency Medicine

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“…Historically, the reluctance among clinicians to provide analgesia to patients with acute abdominal pain 12,28,29 was thought to be due to concerns of obscuring the diagnosis of appendicitis, 30,31 leading to a delay in surgical management. 32,33 In a number of previous surveys of emergency physicians 23,28 and surgeons 19 , a large proportion of respondents chose not to provide analgesia until after surgical consultation.…”

Section: Discussionmentioning

confidence: 99%

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

Poonai

Cowie

Davidson

et al. 2016

CJEM

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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.

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“…Dans notre étude, ces DANS représentaient 41 % des diagnostics de sortie inscrits sur les dossiers médicaux. Ce résultat est en accord avec les données de la littérature où les DANS ont une prévalence entre 19 % à 41 % selon les séries [2,7,8,16,20,26,27]. Dans notre étude, les DANS n'étaient pas significativement associés à une chronicisation des douleurs.…”

Section: Discussionunclassified

Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

Durand

Bounes

Lauque

2015

Ann. Fr. Med. Urgence

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Objectif : L'objectif de notre étude était de détermi-ner l'incidence de la chronicisation des douleurs chez les patients ayant consulté aux urgences pour une douleur abdominale aiguë non traumatique. Patients et méthode : Nous avons réalisé une étude rétrospec-tive au sein des urgences d'un hôpital universitaire entre juin 2013 et juin 2014. Les patients ont été sélectionnés via la banque informatisée des données des urgences, puis contactés pour un entretien téléphonique trois mois après leur passage aux urgences. Le critère de jugement principal était la persistance d'un score douloureux par échelle numérique (EN) supérieur à 3, à une fréquence minimale de deux fois par mois, trois mois après le passage aux urgences. Résultats : Sur les 440 patients éligibles, 200 patients ont pu être contactés et ont donné leur consentement. Quarante-deux patients (21 %) décrivaient la persistance d'une douleur avec une EN supérieure à 3/10 au moins deux fois par mois. Les facteurs associés à un risque de chronicisation étaient : l'âge (ratio de côtes (RC) 1,02 IC95 % [1,01-1,05] par année) et le score de la classification clinique des malades aux urgences (RC 0,40 IC95 % [0,21-0,75] par unité). Cent vingt-deux patients (61 %) n'ont pas présenté de récidive douloureuse dans les trois mois suivant leur admission aux urgences. Conclusion : La chronicisation des douleurs après une consultation aux urgences pour des douleurs abdominales aiguës concerne un patient sur cinq. L'âge et la gravité initiale de l'état clinique sont des facteurs prédictifs de chronicisation. L'absence de diagnostic organique (41 %) n'était pas associée, dans notre étude, à un risque de chronicisation. Mots clés Douleur abdominale · Chronicisation · OligoanalgésieAbstract Objective: The aim of this study was to investigate incidence of chronicization of pain in patients suffering from acute non-traumatic abdominal pain and discharged from emergency department (ED). Methods: We conducted a retrospective study in an academic hospital ED between June 2013 and June 2014. Patients were selected on ED electronic database, and then contacted for a phone interview three months after discharge. The main outcome was a pain score up to 3/10 on a numerous scale, more than twice a month, three months after discharge from ED. Results: Among the 440 patients completing inclusion criteria, 200 patients were contacted and gave their consent. Forty-two patients (21%) reported abdominal pain with an intensity more than 3/10 and with a frequency more than twice a month. Factors associated with pain chronicization where age (odds-ratio (OR) 1,02 IC95% [1,01-1,05] pear year and clinical gravity score at admission (OR 0,40 IC95% [0,21-0,75] pear level). One hundred and twenty two patients (61%) reported no pain during the three months of follow-up. Conclusions: One patient out of five is exposed to chronicization of his abdominal pain three months after discharge from ED. Age and clinical gravity score at admission are risk factors for pain chronicization. The lack of organic d...

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Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

Cited by 57 publications

References 78 publications

Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

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

Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

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