title: Are We Adequately Treating Pain in Children Who Present to US Emergency Departments?: Factors That Contribute to Pain Treatment in Pediatric Patients.
abstract: OBJECTIVE
  There are no recent national data on analgesic use for pain treatment in children. Our objective was to determine if there is adequate pain treatment for children in US emergency departments (EDs) and determine predictors of nonopioid and opioid analgesic administration.
  
  
  METHODS
  Children younger than 18 years with the diagnosis of extremity fracture, appendicitis, or urinary tract stones were obtained from the National Health Ambulatory Medical Care Survey (NHAMCS) (2006-2010) and analyzed using logistic regression for complex samples. There were 2 analyses: (1) those who received analgesics versus those who did not; and (2) of those who received analgesics, opioid versus nonopioid analgesic use.
  
  
  RESULTS
  There were 1341 records analyzed representing 4.5 million ED visits. Those who received analgesics were more likely to be older than age of 3 years (P = 0.05), be discharged from the hospital (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.94), arrive between noon and midnight (OR, 0.1.85; CI, 1.12-3.03), and have a higher pain rating (P < 0.01). Children who received opioid analgesics were more likely to live outside the Northeast (P = 0.04), require admission (OR, 2.95; CI, 1.09-7.98), have a higher acuity triage level (OR, 1.79; CI, 1.04-3.06), have higher pain scores (P < 0.01), and have private insurance (OR, 1.75; CI, 1.06-2.94).
  
  
  CONCLUSIONS
  There is still a lot of room for improvement of pediatric pain control in US EDs. We aim to apply this information toward direct physician and nursing education interventions, including the recognition of age appropriate pain cues, and parental information and guidance to improve pediatric pain treatment in US EDs.
authors.affiliation: From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, KY.
authors.forename: Katelyn Johnson
authors.initials: KJ
authors.lastname: Yackey
authors.forename: Annie Heffernan
authors.initials: AH
authors.lastname: Rominger
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000700:Analgesics