title: Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department: The TRAPPED survey.
abstract: BACKGROUND
  Management of children's pain and anxiety in the emergency department is likely suboptimal.
  
  
  OBJECTIVE
  To determine the availability of currently used strategies in Canadian paediatric emergency departments.
  
  
  METHODS
  A cross-sectional survey involving all centres of the Pediatric Emergency Research Canada group was performed. The primary outcome was the availability of specific procedures for pain and anxiety management for children in the emergency department. One person per centre was identified to complete the survey. Data were collected from October 2013 to January 2014 using an electronic survey tool.
  
  
  RESULTS
  All 15 Pediatric Emergency Research Canada centres agreed to participate. The verbal numerical scale was widely used (80%) to assess pain. One-half of respondents (53%) had access to a child life specialist. The following techniques were available for minor procedures: television as a distraction tool (87% of respondents), topical anesthetic before intravenous needle insertion (73%) and positioning of the child on parent's lap (60%); most remaining centres reported that these could be easily implemented. Intravenous morphine was available at every centre. Intranasal fentanyl was available (60%) or considered to be easy to implement (33%). Few centres reported availability of clinical guidelines regarding pain for doctors (27%) and nurses (40%); all respondents considered them to be easy to implement.
  
  
  CONCLUSIONS
  There was wide variation in paediatric pain and anxiety management strategies among tertiary care Canadian emergency departments. Several pain-reduction procedures (distraction, positioning on parent's lap, topical anesthetic, intranasal administration) were identified that could be easily implemented to address the gap.
authors.affiliation: Division of Pediatric Emergency Medicine, Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec;
authors.forename: Evelyne D
authors.initials: ED
authors.lastname: Trottier
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta; ; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta;
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.affiliation: Centre hospitalier universitaire Sainte-Justine Research Centre; ; Faculty of Nursing, University of Montreal, Montreal, Quebec.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Le May
authors.affiliation: Division of Pediatric Emergency Medicine, Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec; ; Centre hospitalier universitaire Sainte-Justine Research Centre;
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gravel
keywords: Anxiety; Emergency department; Needle pain; Paediatric; Paediatric pain management; Procedural pain