title: Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments.
abstract: OBJECTIVE
  Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation.
  
  
  METHODS
  Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014.
  
  
  RESULTS
  Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition.
  
  
  CONCLUSIONS
  Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.
authors.affiliation: *Division of Emergency Medicine,London Health Sciences Centre,Western University,London, ON.
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.affiliation: *Division of Emergency Medicine,London Health Sciences Centre,Western University,London, ON.
authors.forename: Allyson
authors.initials: A
authors.lastname: Cowie
authors.affiliation: *Division of Emergency Medicine,London Health Sciences Centre,Western University,London, ON.
authors.forename: Chloe
authors.initials: C
authors.lastname: Davidson
authors.affiliation: ‡Hospital for Sick Children,Department of Gastroenterology,University of Toronto,Toronto, ON.
authors.forename: Andréanne
authors.initials: A
authors.lastname: Benidir
authors.affiliation: §Department of Pediatrics,University of Calgary,Calgary, AB.
authors.forename: Graham C
authors.initials: GC
authors.lastname: Thompson
authors.affiliation: ║Centre hospitalier de l'Université Laval,CHU de Quebec, QC.
authors.forename: Philippe
authors.initials: P
authors.lastname: Boisclair
authors.affiliation: **Children's Hospital of Eastern Ontario,University of Ottawa,Ottawa, ON.
authors.forename: Stuart
authors.initials: S
authors.lastname: Harman
authors.affiliation: *Division of Emergency Medicine,London Health Sciences Centre,Western University,London, ON.
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.affiliation: ††Division of Paediatric Surgery, London Health Sciences Centre,Western University,London, ON.
authors.forename: Andreana
authors.initials: A
authors.lastname: Butter
authors.affiliation: *Division of Emergency Medicine,London Health Sciences Centre,Western University,London, ON.
authors.forename: Rod
authors.initials: R
authors.lastname: Lim
authors.affiliation: ‡‡Department of Pediatrics,University of Alberta,Edmonton, AB.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000188:drug therapy*; D059787:Acute Pain / Q000188:drug therapy; D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: abdominal pain; analgesia; appendicitis; pediatric; survey