Emergency Department Pain Management in Children With Appendicitis in a Biethnic Population.
OBJECTIVE
Our goal was to examine factors associated with the administration of emergency department analgesia (any analgesia, opioid analgesia) in patients with acute appendicitis in a tertiary children's hospital in Israel, and to examine ethnic differences.


METHODS
A retrospective cohort study of children evaluated in the emergency department, who had International Classification Of Disease-Ninth Revision (ICD-9) diagnosis of acute appendicitis. Regression analysis was used to test the effect of multiple variables on the provision of analgesia. Medications were administered according to a nurse-driven pain protocol. Multivariate regression was performed to estimate the strength of association between ethnicity and provision of analgesia. The effect of patient-nurse ethnicity concordance was assessed.


RESULTS
During the 6-year study period, there were 715 children with acute appendicitis, 457 Jews and 258 Arabs. Overall, 289 (40.4%) received some form of analgesia, and 139 (19.4%) received opioid analgesia. Univariate analysis revealed that higher pain score (P<0.001) and higher triage acuity (P<0.001) were associated with administration of any type of analgesia and of opioid analgesia. When adjusted for age, weight, sex, triage category, pain score, and 24-hour time of arrival, Jewish and Arab patients had similar likelihood of receiving analgesia of any type 41.8% (95% confidence interval [CI], 40.3%-43.3%) versus 40.7% (95% CI, 38.7%-42.8%), and receiving opioid analgesia 26.1% (95% CI, 24.4%-27.8%) versus 25.3% (95% CI, 22.9%-27.7%). Similar proportions of Jewish and Arab patients received analgesia from Jewish and Arab nurses.


CONCLUSIONS
Low rates of analgesia and opioid administration were found with no ethnic differences.
*Emergency Department, Ruth Children's Hospital §Quality of Care Unit, Rambam Health Care Campus ‡Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel †Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Ron
R
Jacob
Baruch
B
Krauss
Gal
G
Twito
Ronit
R
Leiba
Itai
I
Shavit
D000700:Analgesics / Q000627:therapeutic use*; D001064:Appendicitis / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002985:Clinical Protocols; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007557:Israel; D008297:Male; D015999:Multivariate Analysis; D009726:Nurses; D010146:Pain / Q000208:ethnology* / Q000503:physiopathology; D059408:Pain Management; D012044:Regression Analysis; D012189:Retrospective Studies; D062606:Tertiary Care Centers
D000700:Analgesics