title: Physician pain reminder as an intervention to enhance analgesia for extremity and clavicle injuries in pediatric emergency.
abstract: The purpose of this study was to document analgesic use for limb and clavicle injuries in the pediatric emergency department (ED) and to determine whether a physician-oriented pain scale form on the patient's chart would enhance the administration of analgesia. Patients 3 to 18 years old were recruited prospectively in our tertiary pediatric ED in Toronto. The study included 4 crossover periods, 2 with the pain scale form on the patient's chart and 2 without. A total of 310 patients were recruited, mean age was 10 years, 64% were boys, and 62% had sustained fractures. The mean pain score was 4.4. Only 90 (29%) patients received an analgesic in the ED, and 65 (72%) of them were ordered by a physician. Only 24 (20%) in the study group and 22 (14%) in the control group received sufficient analgesia (P = .13). The median time to physician-initiated analgesia after arrival was 2.0 hours (1.0 to 3.3 hours), without a significant difference between groups. Pain control was 4-fold more appropriate in children receiving opioids versus nonopioids. Physician pain reminders did not enhance, and other measures should be taken to increase the dispensing of analgesia.
  
  
  CONCLUSIONS
  This is the first study to evaluate whether the addition of a physician-oriented pain-scale form on the chart of patients with injuries improves administration of analgesia in the ED. We found that physicians do not give sufficient analgesia even with this reminder form.
authors.affiliation: Pediatric Research in Emergency Therapeutics Program, Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alex L
authors.initials: AL
authors.lastname: Rogovik
authors.forename: Maryam
authors.initials: M
authors.lastname: Rostami
authors.forename: Shaun
authors.initials: S
authors.lastname: Hussain
authors.forename: Ran D
authors.initials: RD
authors.lastname: Goldman
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000293:injuries*; D011307:Drug Prescriptions; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005121:Extremities / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000187:drug effects; D010820:Physicians; D011446:Prospective Studies; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D000700:Analgesics