title: Pain management of acute appendicitis in Canadian pediatric emergency departments.
abstract: OBJECTIVE
  Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs).
  
  
  METHODS
  A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision.
  
  
  RESULTS
  A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years. Sixty-one percent (381/616) of patients received analgesia in the ED; 42.8% (264/616) received IV morphine. Other analgesic agents provided included oral acetaminophen (23.5% [145/616]) and oral ibuprofen (5.8% [36/616]). The median (IQR) initial dose of IV morphine was 0.06 (0.04, 0.09) mg/kg. The median (IQR) time from triage to the initial dose of analgesia was 196 (101, 309.5) minutes. Forty-three percent (117/269) of children receiving analgesia received the initial dose following surgical consultation; 43.7% (121/277) received their first analgesic after abdominal ultrasound was performed.
  
  
  CONCLUSIONS
  Suboptimal and delayed analgesia remains a significant issue for children with suspected appendicitis in Canadian PEDs. This suggests a role for multidimensional knowledge translation interventions and care protocols to improve timely access to analgesia.
authors.affiliation: *Department of Pediatrics,University of Calgary,Calgary,AB.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Robb
authors.affiliation: †Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.affiliation: §Department of Pediatrics,Western University,London,ON.
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.affiliation: *Department of Pediatrics,University of Calgary,Calgary,AB.
authors.forename: Graham C
authors.initials: GC
authors.lastname: Thompson
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000208:Acute Disease; D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D001064:Appendicitis / Q000150:complications*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012189:Retrospective Studies
keywords: appendicitis; child; narcotics; pain management