Paediatric analgesia in the emergency department, are we getting it right?
OBJECTIVE
To measure the dose discrepancy in prescribing simple paediatric analgesia, in the emergency department, by comparing age and actual weight-based dosing. To establish the accuracy of the weight-estimation formula for children [weight kg=2 (age years+4)].


METHODS
A prospective survey conducted in the emergency departments of a UK teaching hospital and district general hospital. Two hundred and forty-seven children were prescribed simple analgesia in the form of paracetamol and ibuprofen or both. The dose prescribed was based on age. All children were weighed and a maximum dose based on the child's weight was calculated. The individual child's weight was also compared with the weight calculated using the estimation formula.


RESULTS
A total of 247 patients were included. Two hundred and thirty-three patients were prescribed paracetamol. Fifteen patients were prescribed ibuprofen. The paracetamol group was administered a mean dose that was 67% (P<0.001) of the optimal dose that was based on weight. Ibuprofen dosage was 51% (P<0.001) of optimal dose. The weight-estimation formula underestimated weight by 16% (P<0.001).


CONCLUSIONS
Prescribing analgesia by age often results in significant underdosing in the paediatric population. Predicting a child's weight using the calculation may result in underdosing.
Donald
Colin
C
Accident and Emergency, Ninewells Hospital, Dundee, Scotland, UK. colin.donald@tuht.scot.nhs.uk
Duncan
Russell
R
Blair
Lorraine
L
Thakore
Shobhan
S
Clark
Michael
M
D000082:Acetaminophen / Q000008:administration & dosage*; D000367:Age Factors; D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies; D012606:Scotland
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D007052:Ibuprofen