title: Acetaminophen dose accuracy and pediatric emergency care.
abstract: OBJECTIVE
  To describe the demographic and clinical characteristics of children who receive acetaminophen per emergency department standing orders and identify factors associated with supratherapeutic doses (>or=16 mg/kg).
  
  
  METHODS
  A cross-sectional retrospective study of consecutive children who received acetaminophen at an urban children's hospital emergency department.
  
  
  RESULTS
  Over a 1-week period, 156 (24%) of 661 emergency department children were treated with acetaminophen. Of the children receiving acetaminophen, 64 (41%) were less than 2 years and 92 (59%) were males. The indication for acetaminophen was fever in 140 (90%) children, and 70 (50%) had temperatures >or=39degreesC. The route of administration was oral [133 (85%)] and rectal [23 (15%)]. There were 122 (78%) correct doses (standing order dose range of 10 to 15 mg/kg), 15 (10%) doses of <10 mg/kg, and 19 (12%, 95% CI, 8% to 18%) doses of >or=16 mg/kg. In comparison, children who received acetaminophen at normal or low doses (<16 mg/kg) versus supratherapeutic doses (>or=16 mg/kg) showed a significant difference in route. The rate of rectal route was significantly greater in the supratherapeutic doses (95% CI for changes in proportion, 14% to 48%).
  
  
  CONCLUSIONS
  Review of acetaminophen dose accuracy, particularly the rectal route, is recommended for emergency departments with standing orders for acetaminophen.
authors.affiliation: Children's Hospitals and Clinics-St. Paul, Emergency Department, 345 North Smith Avenue, St. Paul, MN 55102, USA. joseph.losek@childrenshc.org
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Losek
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000284:Administration, Oral; D000285:Administration, Rectal; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000453:epidemiology / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000188:drug therapy; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen