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

Abstract

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...

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

“…Our results support the possibility that awareness has increased regarding the importance of providing analgesia to children with acute abdominal pain. Our findings are also consistent with a 2013 Canadian survey of PEPs 24 that found only 4% of respondents stated they would withhold analgesia in the case of a child with suspected "surgical abdomen." However, both the 2013 self-reported finding and our findings may be incongruent with directly observed practice.…”

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge

“…2 In spite of this, oligoanalgesia and inadequate pain management constitute a phenomenon that is still a major problem in clinical practice, 5,10,11 as previously seen and demonstrated in our setting. The main problems that have been detected are the scarce assessment of pain, the use of treatments as needed instead of at scheduled intervals, and the administration of analgesics in the emergency room to less than a half of patients.…”

“…1 A l t h o u g h p a i n i s a c o m m o n symptom seen at the emergency department, 2 several studies have demonstrated that pain management is inadequate. 3 There are multiple causes for this: difficulty to assess pain, fear to use strong analgesics, and use of medications on an as needed basis instead of at scheduled intervals.…”

Evaluación del manejo del dolor de la patología facial y oral en un Servicio de Urgencias Pediátrico y tras el alta domiciliaria

“…2 A pesar de esto, la oligoanalgesia y el inadecuado tratamiento del dolor es un fenómeno que continúa constituyendo un problema importante en la práctica clínica, 5,10,11 como se ha visto previamente y se ha demostrado en nuestro medio. Los principales problemas detectados han sido escasa evaluación del dolor, uso de tratamientos a demanda en lugar de pautado y administración de analgésicos en el SUP en menos de la mitad de los pacientes.…”

“…1 A pesar de que el dolor es un síntoma frecuente en los servicios de urgencias, 2 numerosos estudios han demostrado que su manejo es inadecuado. 3 Existen múltiples causas: dificultad para su evaluación, miedo al uso de analgésicos potentes y uso de medicación a demanda en lugar de pautada.…”