Children less likely to be treated for pain
Children presenting in an emergency department are less likely than adults to receive pain medication for appendicitis.
Published online 30 March 2016
A doctor examines a child's abdomen for appendicitis.
© © PhotoAlto / Alamy Stock Photo
Researchers in Canada compared the charts of 92 adults and 73 children who presented to an emergency department (ED) and were diagnosed with appendicitis1. They found that only 40% of the children — compared to 80% of the adult patients — were given pain medication during their ED stay. They were also significantly less likely than adults (27% to adults’ 71%) to receive opioid analgesics in particular, the researchers report.
“Our study shows that a large number of children who appeared to have moderate to severe pain caused by appendicitis did not receive appropriate pain medication, out of proportion to their adult counterparts”, says family physician Christopher Krause, who specializes in emergency medicine. “To us, this suggests that opportunities to provide pain control to children are being missed”.
Krause, a researcher at the University of Saskatchewan in Canada, says the data they collected does not allow them to fully say why this discrepancy occurred or what would have been the ‘correct’ amount of pain medication to administer. “Good quantitative research regarding these barriers is not available at the moment but the study could stimulate physicians, nurses and other ED health professionals to identify and address barriers in their particular institutions”, he says.
Current medical practice supports optimal pain control to promote quick and full recovery in patients. It also helps the prevention of secondary problems, explains Krause. But there seem to be numerous barriers to providing good pain control in children. These might include learned practices from senior physicians, a lack of understanding of the importance of pain control, difficulty in assessing pain in children, reluctance to insert intravenous drips into children’s veins and concerns from parents and physicians about the effects of analgesics on children.
“Ultimately, we must remember that pain of some kind is the most common reason that patients present to the emergency department,” says Krause. “As emergency physicians, we must make a conscious effort to manage our patients’ pain while we are simultaneously identifying and treating its underlying cause.”
The next steps, he says, would be to follow patients in the ED to obtain data on patient perceptions of their pain management and obstacles to its effective management. “This would be a difficult study to design and would be much more resource intensive, but I think the information it could provide would be invaluable,” he says.Reference
Karreman, E., Krause, C. S. & Smith, S. Children receive less analgesia in general ERs than adults: a retrospective study. J. Emerg. Med. Trauma Acute Care 2016, 1 (2016). | article
DOI: 10.1038/qsh.2016.105
