Emergency Department Analgesic Use in Pediatric Trauma Victims With Fractures

Friedland, Leonard R.; Kulick, Roy M.

doi:10.1016/s0196-0644(94)70031-1

Cited by 95 publications

(25 citation statements)

References 12 publications

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“…32 The pain associated with a surgical abdomen and fractures was reported to be rarely untreated, and IV opioids were the most common choice of analgesia, as is consistent with current best evidence. 6,8,[33][34][35] Codeine was still used by over 25% of physicians in 2009 for presenting pain. An informal survey of the PERC membership in 2012 indicated that this practice has decreased significantly.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 Children are at especially high risk for experiencing pain during their visit and frequently receive inadequate analgesia. [4][5][6][7][8][9][10] Inadequate management of children's pain can be attributed to multiple factors, including fear of adverse reactions, difficulty in the recognition of pain, fear of dependency, fear of overprescribing, and the misperception that neonates and young children do not experience pain as intensely as adults.…”

Section: Ré Sumémentioning

confidence: 99%

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Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉObjectifs: L'é tude visait à dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et à examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi à repé rer les sujets é ventuels, et une version modifié e de la Dillman's Total Design Survey Method a é té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse à l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins é taient â gé s de 31 à 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingtquatre pour cent des mé decins ont fait é tat d'une documentation obligatoire sur l'é valuation de la douleur dans leur é tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) é taient souvent prescr...

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Section: Discussionmentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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“…11,12 ED management of children's pain remains suboptimal. [13][14][15][16][17][18][19][20][21][22] MSK pain in very young children has been found to be particularly undertreated when compared to MSK pain in school-aged children. 23 To create system improvements in pain management, it is first important to define the analgesic practice patterns of physicians treating pediatric MSK injuries in Canadian EDs.…”

Section: Ré Sumémentioning

confidence: 99%

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Kircher

Drendel

Newton

et al. 2014

CJEM

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Objective: Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children's MSK pain, both in the ED and postdischarge. Methods: We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care. Results: A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes. Conclusions: Documentation of the assessment and management of children's pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ''door to analgesia'' time for children in pain. RÉ SUMÉObjectif: Les blessures musculosquelettiques (MS) douloureuses chez les enfants sont un motif fré quent de consultation au service des urgences (SU). L'é tude avait pour objectif principal de dé crire les pratiques actuelles de l'administration des analgé siques dans la prise en charge des douleurs MS, en mode ambulatoire, tant au SU qu'à domicile, aprè s le congé de l'hô pital. Mé thode: Ont é té passé s en revue les dossiers mé dicaux d'enfants consé cutifs, examiné s dans un SU gé né ral ou un SU pé diatrique (Edmonton [Alberta]) au cours de quatre mois civils ré partis é galement, pour un diagnostic de fracture, de dislocation, de foulure ou d'entorse d'un membre. Les renseignements recueillis comprenaient des donné es dé mographiques, les analgé siques administré s, les cotes de la douleur, les conseils sur les mé dicaments donné s au moment du congé et la duré e des soins cliniques. Ré sultats: Au total, 543 dossiers mé dicaux ont é té examiné s (n 5 468 au SU pé diatrique; n 5 75 au SU gé né ral). Dans 19% d'entre eux é tait consigné e la prise d'analgé siques en phase pré hospitaliè re; dans 34%, l'administration d'analgé siques au SU; dans 13%, l'administration de sé dation-analgé sie à des fins interventionnelles; et dans 24%, la prestation de conseils sur l'analgé sie au moment du congé . Parmi les enfants à qui l'on a prescrit des ana...

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“…[2][3][4][5][6] This has led to inadequate treatment of children in pain and unnecessary suffering in a particularly vulnerable group of patients-sick or injured children and infants. [7][8][9][10] There seems to be two main reasons for the belief that children do not experience pain to the same degree as adults. Firstly, it was thought that children were less able to feel pain as their nervous system is immature and incompletely myelinated.…”

Section: Current Practice and Perspectivesmentioning

confidence: 99%

“…No significant clinical difference was detected between the analgesic and nonanalgesic group. 8 Selbst and Clark in 1990 performed a retrospective review to see if children received similar analgesic treatment to adults when presenting with similar acutely painful conditions, such as sickle cell crises, long bone fractures and burns. Sixty per cent of adults with painful conditions received no analgesia at all, but children were much less likely to receive analgesia than adults (28%, p=0.001).…”

Section: Emergency Provision Of Analgesia In the Paediatric Populationmentioning

confidence: 99%

Emergency analgesia in the paediatric population. Part I Current practice and perspectives

Maurice

O'Donnell²,

Beattie³

2002

Emergency Medicine Journal

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Emergency Department Analgesic Use in Pediatric Trauma Victims With Fractures

Cited by 95 publications

References 12 publications

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Emergency analgesia in the paediatric population. Part I Current practice and perspectives

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