title: Appendicitis and Analgesia in the Pediatric Emergency Department: Are We Adequately Controlling Pain?
abstract: OBJECTIVE
  The primary objective of the study was to compare analgesia-prescribing practices and timing of analgesia administration between pediatric emergency medicine (PEM) and general emergency medicine (GEM) practitioners for children with appendicitis. The secondary objective was to compare analgesia administration versus triage pain score, pediatric appendicitis score (PAS), and body mass index (BMI).
  
  
  METHODS
  This was a retrospective chart review of patients younger than 21 years who presented to either an urban pediatric emergency department (ED) or 2 general EDs and were diagnosed with appendicitis.
  
  
  RESULTS
  Two hundred eighteen charts were reviewed, 153 (70%) from the pediatric ED and 65 (30%) from the general EDs. The patients seen by PEM physicians were younger than the patients seen by GEM physicians (mean age, 12.8 vs 15.4 years; P = 0.002). The patients evaluated by GEM physicians were more likely to receive analgesia in the ED (82% vs 60%, P = 0.003) and received analgesia sooner (mean, 178 vs 239 minutes; P = 0.026) than the patients evaluated by PEM physicians. The patients with triage pain scores higher than 6 of 10 were more likely to receive analgesia than the patients with pain scores lower than 6 (71% vs 51%, P = 0.015). There was no association between PAS or BMI and analgesia administration or time to analgesia (P = not significant).
  
  
  CONCLUSIONS
  The patients with appendicitis evaluated by GEM physicians were more likely to receive analgesia and receive analgesia quicker than the patients evaluated by PEM physicians. The patients with higher pain scores were more likely to receive analgesia, but PAS and BMI did not affect analgesia administration.
authors.affiliation: From the *Department of Pediatrics, Division of Pediatric Emergency Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; †Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Bellevue Hospital/New York University School of Medicine, New York; and ‡Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Delaney
authors.forename: Alexis
authors.initials: A
authors.lastname: Pankow
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Avner
authors.forename: Joni E
authors.initials: JE
authors.lastname: Rabiner
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage*; D001064:Appendicitis / Q000188:drug therapy*; D002648:Child; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage
chemical_list: D000700:Analgesics