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Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

  • Naveen Poonai (a1) (a2), Victoria Brzozowski (a2), Antonia S. Stang (a3), Amy L. Drendel (a4), Philippe Boisclair (a5), Michael Miller (a2), Stuart Harman (a6), Samina Ali (a7) and Pediatric Emergency Research Canada (PERC) (a1) (a2) (a3) (a4) (a5) (a6) (a7)...
  • Please note a correction has been issued for this article.

Abstract

Objectives

Lumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient and provider-specific barriers.

Methods

We surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from May 1 to August 1, 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs.

Results

For a 3-week old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 [100%] of pediatric EPs and 261/262 [99.6%] of general EPs) and a 3-year-old (142/144 [98.6%] of pediatric EPs and 256/262 [97.7%] of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%).

Conclusion

Compared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.

Objectifs

Les ponctions lombaires (PL) sont douloureuses chez les enfants, et les sociétés savantes recommandent de recourir à l’analgésie. Toutefois, moins du tiers des urgentistes pédiatres (UP) respectent les recommandations. Aussi l’étude visait-elle à évaluer la volonté des UP et celle des urgentistes généralistes (UG) de procéder à l’analgésie, et à examiner les obstacles propres aux patients et aux fournisseurs de soins.

Méthode

Une enquête a été menée parmi les médecins inscrits dans les bases de données du réseau Pediatric Emergency Research Canada et de l’Association canadienne des médecins d’urgence, du 1er mai au 1er août 2016, concernant des scénarios possibles de PL effectuée chez un nourrisson de 3 semaines, un enfant de 3 ans et un autre de 16 ans. Le principal critère d’évaluation consistait en la volonté de procéder à l’analgésie. Les critères d’évaluation secondaires comprenaient le type d’analgésie, les motifs sous-jacents au non-recours à l’analgésie et la perception de la compétence pour réaliser la PL.

Résultats

En ce qui concerne le cas du nourrisson de 3 semaines, 123 UP sur 144 (85,4 %) et 231 UG sur 262 (88,2 %) étaient disposés à procéder à l’analgésie. Par contre, la volonté d’y recourir était quasi générale dans les cas de la PL effectuée chez l’enfant de 16 ans [144 UP sur 144 (100 %) et 261 UG sur 262 (99,6 %)] et chez l’enfant de 3 ans [142 UP sur 144 (98,6 %) et 256 UG sur 262 (97,7 %)]. La raison invoquée le plus souvent par les UP de ne pas recourir à l’analgésie était l’idée selon laquelle l’intervention causerait encore plus de malaise (13/21; 61,9 %). Le même motif a été invoqué par les UG (12/31; 38,7 %), outre le manque de connaissances sur les différentes formes d’analgésie (13/31; 41,9 %).

Conclusions

Les UP et les UG n’étaient pas très disposés à recourir à l’analgésie dans le cas de la PL effectuée chez le nourrisson, contrairement à celle effectuée chez l’enfant d’âge préscolaire ou chez l’adolescent. Il faudrait donc élaborer des stratégies ciblant les idées fausses sur la douleur et le manque de connaissances sur les différentes formes d’analgésie dans le but de changer les pratiques.

Copyright

Corresponding author

*Correspondence to: Dr. Naveen Poonai, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 2V5, Canada; Email: naveen.poonai@lhsc.on.ca

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