Skip to main content Accessibility help
×
×
Home

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

  • Naveen Poonai (a1) (a2), Allyson Cowie (a1), Chloe Davidson (a1), Andréanne Benidir (a3), Graham C. Thompson (a4) (a5), Philippe Boisclair (a6), Stuart Harman (a7), Michael Miller (a1), Andreana Butter (a8), Rod Lim (a1) and Samina Ali (a9) (a10)...

Abstract

Objectives

Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation.

Methods

Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman’s Tailored Design method was used to distribute the survey from June to July 2014.

Results

Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition.

Conclusions

Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

Corresponding author

Correspondence to: Dr. Naveen Poonai, London Health Sciences Centre, London, Ontario, 800 Commissioners Road East, London, ON, N6A 5W9; Email: naveen.poonai@lhsc.on.ca

References

Hide All
1. Ali, S, Chambers, AL, Johnson, DW, et al. Paediatric pain management practice and policies across Alberta emergency departments. Paediatr Child Health 2014;19(4):190-194.
2. Furyk, J, Sumner, M. Pain score documentation and analgesia: a comparison of children and adults with appendicitis. Emerg Med Australas 2008;20(6):482-487.
3. Todd, KH, Ducharme, J, Choiniere, M, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain 2007;8(6):460-466.
4. Goldman, RD, Crum, D, Bromberg, R, et al. Analgesia administration for acute abdominal pain in the pediatric emergency department. Pediatr Emerg Care 2006;22(1):18-21.
5. Herd, DW, Babl, FE, Gilhotra, Y, et al. Pain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council’s National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborati. Emerg Med Australas 2009;21(3):210-221.
6. Bauman, BH, McManus, JG Jr. Pediatric pain management in the emergency department. Emerg Med Clin North Am 2005;23(2):393-414.
7. Drendel, AL, Brousseau, DC, Gorelick, MH. Pain assessment for pediatric patients in the emergency department. Pediatrics 2006;117(5):1511-1518.
8. Brown, JC, Klein, EJ, Lewis, CW, et al. Emergency department analgesia for fracture pain. Ann Emerg Med 2003;42(2):197-205.
9. Addiss, DG, Shaffer, N, Fowler, BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(5):910-925.
10. Rasmussen, OO, Hoffmann, J. Assessment of the reliability of the symptoms and signs of acute appendicitis. J R Coll Surg Edinb 1991;36(6):372-377.
11. Sivit, CJ. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatr Radiol 2004;34(6):447-453.
12. Kim, MK, Galustyan, S, Sato, TT, et al. Analgesia for children with acute abdominal pain: a survey of pediatric emergency physicians and pediatric surgeons. Pediatrics 2003;112(5):1122-1126.
13. Manterola, C, Astudillo, P, Losada, H, et al. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev 2011;3:CD005660.
14. Poonai, N, Paskar, D, Konrad, S, et al. Opioid analgesia for acute abdominal pain in children: A systematic review and Meta-analysis. Acad Emerg Med 2014;21(11):1183-1192.
15. Ranji, SR, Goldman, LE, Simel, DL, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 2006;296(14):1764-1774.
16. Brennan, F, Carr, DB, Cousins, M. Pain management: a fundamental human right. Anesth Analg 2007;105(1):205-221.
17. Fein, JA, Zempsky, WT, Cravero, JP, et al. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012;130(5):e1391-e1405.
18. Taddio, A. Effects of early pain experience: The human literature. In Chronic and Recurrent Pain in Children and Adolescents: Progress in Pain Research and Management (eds. McGrath PJ, Finley GA). Seattle: IASP Press; 1999: 57-74.
19. Villain, C, Wyen, H, Ganzera, S, et al. Early analgesic treatment regimens for patients with acute abdominal pain: a nationwide survey among general surgeons. Langenbecks Arch Surg 2013;398(4):557-564.
20. Thompson, GC, Schuh, S, Gravel, J, et al. Variations in the diagnosis and management of appendicitis at Canadian pediatric emergency hospitals. Acad Emerg Med 2015;22(7):811-822.
21. , Dillman DA. Mail and Internet Surveys: The Tailored Design Method: 2007 Update with New Internet, Visual, and Mixed-Mode Guide. Hoboken, NJ: John Wiley & Sons; 2011.
22. Burns, KE, Duffett, M, Kho, ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 2008;179(3):245-252.
23. Wolfe, JM, Lein, DY, Lenkoski, K, et al. Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. Am J Emerg Med 2000;18(3):250-253.
24. Ali, S, Chambers, A, Johnson, DW, et al. Reported practice variation in pediatric pain management: A survey of Canadian pediatric emergency physicians. CJEM 2014;16(5):352-360.
25. Green, RS, Kabani, A, Dostmohamed, H, et al. Analgesic use in children with acute abdominal pain. Pediatr Emerg Care 2004;20(11):725-729.
26. Zimmerman, O, Halpern, P. Opinion survey of analgesia for abdominal pain in Israeli emergency departments. Isr Med Assoc J 2004;6(11):681-685.
27. Mindell, JS, Coombs, N, Stamatakis, E. Measuring physical activity in children and adolescents for dietary surveys: practicalities, problems and pitfalls. Proc Nutr Soc 2014;73(2):218-225.
28. Ayoade, BA, Tade, AO, Salami, BA, et al. Administration of analgesics in patients with acute abdominal pain: a survey of the practice of doctors in a developing country. Int J Emerg Med 2009;2(4):211-215.
29. Jawaid, M, Masood, Z, Ayubi, TK. Pre-operative analgesia in the accident and emergency department. J Coll Physicians Surg Pak 2009;19(6):350-353.
30. Falch, C, Vicente, D, Häberle, H, et al. Treatment of acute abdominal pain in the emergency room: a systematic review of the literature. Eur J Pain 2014;18(7):902-913.
31. Nissman, SA, Kaplan, LJ, Mann, BD. Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation. Am J Surg 2003;185(4):291-296.
32. Armstrong, FD. Analgesia for children with acute abdominal pain: a cautious move to improved pain management. Pediatrics 2005;116(4):1018-1019.
33. Vane, DW. Efficacy and concerns regarding early analgesia in children with acute abdominal pain. Pediatrics 2005;116(4):1018.
34. Mills, AM, Shofer, FS, Chen, EH, et al. The association between emergency department crowding and analgesia administration in acute abdominal pain patients. Acad Emerg Med 2009;16(7):603-608.
35. Grundmann, RT, Petersen, M, Lippert, H, et al. [The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management]. [Article in German]. Z Gastroenterol 2010;48(6):696-706.
36. Smink, DS, Finkelstein, JA, Garcia Peña, BM, et al. Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg 2004;39(3):458-463.
37. Neighbor, ML, Baird, CH, Kohn, MA. Changing opioid use for right lower quadrant abdominal pain in the emergency department. Acad Emerg Med 2005;12(12):1216-1220.
38. Hashikawa, C, Burke, TF, Pallin, DJ, et al. Analgesia administration for acute abdominal pain: a survey of emergency physicians. Ann Emerg Med 2007;50(1):91-92.
39. Gallagher, EJ, Esses, D, Lee, C, et al. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006;48(2):150-160; 160.e1-4.
40. Fein, J, Zempsky, W, Cravero, J, and the Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. Relief of pain and anxiety in pediatric patients in emergency medical systems; American Academy of Pediatrics. Pediatrics 2012;130(5):e1391-e1405.
41. Sharwood, LN, Babl, FE. The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies. Paediatr Anaesth 2009;19(5):445-451.
42. Amoli, HA, Golozar, A, Keshavarzi, S, et al. Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial. Emerg Med J 2008;25(9):586-589.
43. LoVecchio, F, Oster, N, Sturmann, K, et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15(6):775-779.
44. Mahadevan, M, Graff, L. Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000;18(7):753-756.
45. Pace, S, Burke, TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996;3(12):1086-1092.
46. Thomas, S, Silen, W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg 2003;90(1):5-9.
47. Kellogg, KM, Fairbanks, RJ, O’Conn, AB, et al. Association of pain score documentation and analgesic use in a pediatric emergency department. Pediatr Emerg Care 2012;28(12):1287-1292.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Poonai supplementary material S1
Survey

 Word (36 KB)
36 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed