title: Is fever treated more promptly than pain in the pediatric emergency department?
abstract: BACKGROUND
  Fever can be treated with a higher priority than pain in the pediatric emergency department (ED) population.
  
  
  OBJECTIVE
  The primary objective was to assess whether patients with a fever are treated with acetaminophen or ibuprofen more promptly than they are treated for pain.
  
  
  METHODS
  A retrospective descriptive study was performed on all patients between the ages of 3 and 19 years who received acetaminophen or ibuprofen in the pediatric ED from February 1, 2010 to January 31, 2011. The time interval from arrival to treatment with acetaminophen or ibuprofen was compared for those patients with a fever (≥100.4°F) and those without a fever and had reported pain. Other measurable points (time of vital signs, bed assignment, and medication order) on the medical record were compared to further describe any differences.
  
  
  RESULTS
  Pediatric patients with fever (n = 1097) received ibuprofen or acetaminophen a median of 54.0 min (interquartile range [IQR], 35.4-89.3 min) after arrival. The corresponding median time for afebrile patients (n = 1861) that received the same medications was 83.2 min (IQR, 52.7-136.1). The difference between medians was 24.6 min (95% confidence interval 21.3-27.9 min).
  
  
  CONCLUSIONS
  Fever is treated more promptly than pain in the pediatric ED. This difference is associated with prevailing and largely unfounded concerns about fever and the undertreatment of pain (oligoanalgesia).
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Ronald
authors.initials: R
authors.lastname: Dvorkin
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bair
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Hardik
authors.initials: H
authors.lastname: Patel
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Sanford
authors.initials: S
authors.lastname: Glantz
authors.affiliation: New York Colleges of Osteopathic Medicine Educational Consortium, Old Westbury, New York.
authors.forename: David P
authors.initials: DP
authors.lastname: Yens
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rosalia
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Marguilies
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D058633:Antipyretics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D062072:Patient Acuity; D010372:Pediatrics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D058633:Antipyretics; D000082:Acetaminophen; D007052:Ibuprofen
keywords: acetaminophen; acuity; database; electronic medical record; emergency department; fever; ibuprofen; pain; pediatric; triage