1887
Volume 2016, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Background/Introduction: Oligoanalgesia is a common phenomenon in the Emergency Department (ED) with children being especially at risk. However, the extent to which pediatric patients are being undertreated for acute pain in relation to their adult counterparts is not well understood, especially in general (i.e., mixed adult and pediatric) EDs. This study was designed to compare the pain medication received by adult and pediatric patients with appendicitis presenting to a general ED. Methods: A retrospective chart review of 165 patients, 92 adult (mean age: 35.7 ± 15.7 years) and 73 pediatric (mean age: 11.0 ± 3.0 years) with a discharge diagnosis of “appendicitis” were included in this study. Demographic information as well as data regarding type, timing, and received amount of pain medication were collected. Adult and pediatric data were then compared using independent t-test or chi-square analysis. Effect sizes were also calculated. Results: Pediatric patients were significantly more likely than adult patients to not receive any analgesia during their ED stay (58.9% vs 20.7%, p>0.001, Cramer's V = 0.39). They were also significantly less likely to receive opioid analgesics, compared to adults (27.4% vs. 71.7%, p>0.001, Cramer's V = 0.44). Finally, mean pain scores recorded at presentation were significantly lower for children vs. adults (6.5 vs 7.2 out of 10, p = 0.015, r = 0.20). Conclusion: In this sample, pediatric patients with appendicitis presenting to a general emergency department received less opioid pain medication, and less pain medication in general, than their adult counterparts.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2016.1
2016-02-20
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2016/1/jemtac.2016.1.html?itemId=/content/journals/10.5339/jemtac.2016.1&mimeType=html&fmt=ahah

References

  1. Kellogg KM, Fairbanks RJ, O'Connor AB, Davis CO, Shah MN. Association of pain score documentation and analgesic use in a pediatric emergency department. Pediatr Emerg Care. 2012; 28::12871292.
    [Google Scholar]
  2. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989; 7::620623.
    [Google Scholar]
  3. Gueant S, Taleb A, Borel-Kuhner J, Cauterman M, Raphael M, Nathan G, Ricard-Hibon A. Quality of pain management in the emergency department: Results of a multicentre prospective study. Eur J Anaesthesiol. 2011; 28::97105.
    [Google Scholar]
  4. Goldman RD, Crum D, Bromberg R, Rogovik A, Langer JC. Analgesia administration for acute abdominal pain in the pediatric emergency department. Pediatr Emerg Care. 2006; 22:1:1821.
    [Google Scholar]
  5. Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med. 2004; 43::494503.
    [Google Scholar]
  6. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P, PEMI Study Group . Pain in the emergency department: Results of the Pain and Emergency Medicine Initiative (PEMI) multicenter study. J Pain. 2007; 8::460466.
    [Google Scholar]
  7. Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: Are we ever going to get better? J Pain Res. 2009; 2::511.
    [Google Scholar]
  8. Alexander J, Manno M. Underuse of analgesia in very young pediatric patients with isolated painful injuries. Ann Emerg Med. 2003; 41::617622.
    [Google Scholar]
  9. Falch C, Vicente D, Haberle H. Treatment of acute abdominal pain in the emergency room: A systematic review of the literature. Eur J Pain. 2014; 18::902913.
    [Google Scholar]
  10. Kim MK, Galustyan S, Sato TT, Bergholte J, Hennes HM. Analgesia for children with acute abdominal pain: A survey of pediatric emergency physicians and pediatric surgeons. Pediatrics. 2003; 112::11221126.
    [Google Scholar]
  11. Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S, Worster A, Ali S. Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis. Acad Emerg Med. 2014; 21::11831192.
    [Google Scholar]
  12. Bromberg R, Goldman RD. Does analgesia mask diagnosis of appendicitis among children? Can Fam Physician. 2007; 53::3941.
    [Google Scholar]
  13. Manterola C, Vial M, Moraga J, Astudillo P. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011; 1:CD005660.
    [Google Scholar]
  14. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA. 2006; 296::17641774.
    [Google Scholar]
  15. Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen: A survey of emergency medicine physicians. Am J Emerg Med. 2000; 18::250253.
    [Google Scholar]
  16. Voepel-Lewis T, Wagner D, Burke C, Tait AR, Hemberg J, Pechlivanidis E, Malviya S, Talsma A. Early adjuvant use of nonopioids associated with reduced odds of serious postoperative opioid adverse events and need for rescue in children. Paediatr Anaesth. 2013; 23:2:162169.
    [Google Scholar]
  17. Furyk J, Sumner M. Pain score documentation and analgesia: A comparison of children and adults with appendicitis. Emerg Med Australas. 2008; 20::482487.
    [Google Scholar]
  18. Friedland LR, Kulick RM. Emergency department analgesic use in pediatric trauma victims with fractures. Ann Emerg Med. 1994; 23::203207.
    [Google Scholar]
  19. Singer AJ, Gulla J, Thode HC. Parents and practitioners are poor judges of young children's pain severity. Acad Emerg Med. 2002; 9::609612.
    [Google Scholar]
  20. Drendel AL, Kelly BT, Ali S. Pain assessment for children: Overcoming challenges and optimizing care. Pediatr Emerg Care. 2011; 27::773781.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2016.1
Loading
/content/journals/10.5339/jemtac.2016.1
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): analgesiaopioidpain and pediatrics
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error