Analgesia for children with acute abdominal pain: a survey of pediatric emergency physicians and pediatric surgeons.
OBJECTIVE
To evaluate the current opinion and practice of pediatric emergency medicine physicians (PEM) and pediatric surgeons (PS) on the use of opioid analgesia in children with acute abdominal pain during their evaluation in the emergency department.


METHODS
All members of the American Academy of Pediatrics in the Section of Emergency Medicine and the American Pediatric Surgeons Association were mailed a copy of the survey. Inclusion criteria were board-eligible or -certified PEM, or PS certified by American Board of Surgery or Royal College of Surgeons currently in practice whose patient population includes children. Information on primary patient population, years in practice, practice setting, willingness to provide analgesia for acute nontraumatic abdominal pain in children, and the factors influencing their decision were requested. Data were analyzed with the Student t test and chi(2) analysis.


RESULTS
Of 1441 surveys sent, 54 were returned because of incorrect addresses. Of the 1387 presumed received, 702 completed surveys were returned with a response rate of 51%. However, of those who responded, 574 (82%) respondents met our inclusion criteria, and 385 (67%) were PEM and 189 (33%) were PS. Compared with PEM, more PS had >10 years of work experience and were in private practice. More PEM were willing to provide analgesia before definitive diagnosis. However, the overall willingness to provide analgesia was low in both groups. Among the physicians with <10 years of experience, there was no statistical difference between PEM and PS in willingness to provide analgesia. However, among the physicians with >10 years of experience, 61% of PS were less likely to provide analgesia compared with 38% of the PEM (Delta = 23%; 95% confidence interval 13%, 33%). Of the 74 PEM who made optional general comments, 64 (87%) cited disapproval by the PS as the main barrier in providing analgesia.


CONCLUSIONS
The practice of providing analgesia for children with acute abdominal pain is divergent between PEM and PS. More experienced surgeons are less likely to provide analgesia for children with acute abdominal pain. The perceived disapproval of providing analgesia to children with acute abdominal pain by PS is a barrier influencing PEM practice.
Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA. mkim@mail.mcw.edu
Michael K
MK
Kim
Sergey
S
Galustyan
Thomas T
TT
Sato
Jo
J
Bergholte
Halim M
HM
Hennes
D015746:Abdominal Pain / Q000188:drug therapy*; D000208:Acute Disease; D000698:Analgesia / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D003625:Data Collection; D004363:Drug Utilization / Q000706:statistics & numerical data; D004635:Emergency Medicine; D013502:General Surgery; D006801:Humans; D010372:Pediatrics; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
D000701:Analgesics, Opioid