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

Published online by Cambridge University Press:  04 March 2015

Samina Ali ,
Andrea Chambers ,
David W. Johnson ,
Amanda S. Newton ,
Ben Vandermeer ,
Janie Williamson  and
Sarah J. Curtis
Samina Ali*
Affiliation:
Department of Pediatrics, Faculty ofMedicine and Dentistry, University of Alberta, Edmonton, AB
Andrea Chambers
Affiliation:
Department of Pediatrics, Faculty ofMedicine and Dentistry, University of Alberta, Edmonton, AB
David W. Johnson
Affiliation:
Department of Pediatrics, Faculty ofMedicine, University of Calgary, Calgary, AB Alberta Children's Hospital Research Institute, Calgary, AB
Amanda S. Newton
Affiliation:
Department of Pediatrics, Faculty ofMedicine and Dentistry, University of Alberta, Edmonton, AB Women and Children's Health Research Institute, Edmonton, AB
Ben Vandermeer
Affiliation:
Department of Pediatrics, Faculty ofMedicine, University of Calgary, Calgary, AB Alberta Children's Hospital Research Institute, Calgary, AB
Janie Williamson
Affiliation:
Department of Pediatrics, Faculty ofMedicine, University of Calgary, Calgary, AB
Sarah J. Curtis
Affiliation:
Department of Pediatrics, Faculty ofMedicine and Dentistry, University of Alberta, Edmonton, AB Women and Children's Health Research Institute, Edmonton, AB
*
Department of Pediatrics, 3rd Floor, Edmonton Clinic Health Academy, 11405 – 87 Avenue, Edmonton, AB T6G 1C9; [email protected]

Abstract

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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.

Keywords

emergency departmentoligoanalgesiapainpediatricsurvey
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 5 , September 2014 , pp. 352 - 360
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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