Procedural pain management patterns in academic pediatric emergency departments.
OBJECTIVE
To describe the current state of the art for pain and sedation management for five common pediatric emergency department (ED) procedure scenarios.


METHODS
Fellowship directors of U.S. EDs with a pediatric emergency medicine fellowship training program were surveyed by mail and asked to choose the one most commonly used pain or sedation management option for five clinical scenarios: facial laceration repair, cranial computed tomography in a toddler, closed fracture reduction, neonatal lumbar puncture, and intravenous catheter insertion. Results were analyzed by using descriptive statistics, and the differences between high and low volume departments were compared by using a chi-square test.


RESULTS
Thirty-eight of 51 fellowship programs responded (75%). The majority of respondents were fellowship directors (76%). Topical anesthetics were most commonly reported as used for a simple facial laceration (84%), whereas ketamine sedation was most popular for fracture reduction (86%). Pain management for the other scenarios was more variable. More than half of the respondents (53%) would not sedate at all for cranial computed tomography, and only 38% reported use of pharmacologic pain management for intravenous catheter insertion. The majority (74%) reported use of anesthetic (topical or injected local) for neonatal lumbar puncture. High volume departments were more likely to use pain management for intravenous catheter insertions.


CONCLUSIONS
Pain and sedation management methods for pediatric procedures continue to evolve. Despite gains, there is still room for improvement, particularly regarding intravenous catheter insertions.
Bhargava
Rishi
R
Division of Pediatric Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Young
Kelly D
KD
D000700:Analgesics / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005592:Fracture Fixation / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D022125:Lacerations / Q000628:therapy; D010146:Pain / Q000517:prevention & control*; D010372:Pediatrics; D013129:Spinal Puncture / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States
D000700:Analgesics; D006993:Hypnotics and Sedatives