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June 1997
Pain Management in the Emergency Department: Patterns of analgesic utilization.
Petrack EM, Christopher NC, Kriwinsky J; Pediatrics 1997; 99:711-714.
[ see abstract below ]
The Emergency Department (ED) is another place where analgesic requirements can be substantial and practitioners training and experience in prescribing analgesics to pediatric patients can be highly variable. This study is the work of physicians at an academic medical center (Rainbow Babies and Children's Hospital, Case Western Reserve University) and a community academic medical center (MetroHealth Medical Center, Case Western Reserve University).
Petrack et al. conducted the study to compare current differences in analgesic use between adult and pediatric patients with isolated long bone fractures in three different ED settings: an academic medical center with separate pediatric and adult EDs, one with combined pediatric and adult EDs, and a community hospital with a combined ED.
The authors acknowledge the obvious limitations of the retrospective design in their discussion; however, this design does have the advantage of providing a snapshot of care that is given routinely. Not surprisingly, pediatric patients still receive less analgesia, especially discharge medication, than adults, particularly in community hospitals.
The authors also compared their results to those in a subgroup of patients with the same injury in a study published 5 years ago (Selbst SM, Clark M: Ann Emerg Med 1990; 19:1010-1013). This comparison revealed a substantial improvement in analgesic use for adult patients and a more modest improvement for pediatric patients in the ED; pediatric patients received significantly more analgesia at discharge than in the past. It is hoped that the major increase in the literature on and discussion of the importance of pain management for pediatric patients is having some measurable effects.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Objective: To compare the use of analgesia in children to adults in 3 different emergency department (ED) settings.
Methods: Forty adults and 40 pediatric ED charts were randomly selected for review at each of 3 institutions: an academic medical center with separate pediatric and adult EDs (SEP ED), a community academic medical center with a combined ED (COMB ED), and a community hospital with a combined ED (COMTY ED). All patients presenting to the EDs from July 1993 to June 1994 within 12 hours of an isolated long bone fractures were eligible for inclusion. Data were collected on demographics, training of providers, analgesic use and dosing in the ED and on discharge, and time from triage to analgesic use.
Results: The mean pediatric and adult ages were 8.7 and 38.3 years, respectively. Overall, 152/240 (63%) patients received some form of analgesia in the ED, with the COMTY ED (41/80; 51%) offering significantly less analgesia than the COMB ED (58/80; 73%), but not the SEP ED (53/80; 66%). Pediatric patients (64/120; 53%) received significantly less analgesia in the ED than adult patients (88/120; 73%).
This difference was significant at the COMB ED (pediatric 23/40; 58% vs adult 35/40; 88%) and COMTY ED (pediatric 15/40; 38% vs adult 26/40; 65%), but not at the SEP ED (pediatric 26/40; 65% vs adult 27/40; 68%). 195/240 (81%) patients received discharge pain medication. There were no differences between pediatric (93/120; 78%) and adult (102/120; 85%) discharge analgesic prescribing practices. Although there was no difference in appropriateness of analgesic doses in the ED, pediatric patients (20/74; 27%) were more likely than adult patients (3/88; 3%) to receive inadequate doses of analgesics on discharge from the ED.
Conclusions: ED analgesia continues to be used less frequently in the pediatric compared with adult population. Inadequate dosing of discharge analgesic medication in children is a significant problem. Patterns of analgesic utilization may differ in different types of ED settings.
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