title: Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians.
abstract: OBJECTIVE
  To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management.
  
  
  METHODS
  This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.
  
  
  RESULTS
  The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%).
  
  
  CONCLUSIONS
  When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Andrea
authors.initials: A
authors.lastname: Chambers
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Janie
authors.initials: J
authors.lastname: Williamson
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Curtis
mesh_terms: D000328:Adult; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires