151: Analgesic Provision to Pediatric Patients with Acute Abdominal Pain in the Emergency Department: A Survey of Canadian Pediatric Emergency Physicians

Abstract

This study was funded by our institution's associated University's Research Opportunities Fund. The authors have no conflicts of interest to declare. Abdominal pain is the most frequent clinical feature of acute appendicitis, the most common pediatric condition requiring urgent surgical intervention. There is evidence, particularly in children, that analgesia is underutilized for abdominal pain. Historically, the reluctance to provide analgesia to patients was thought to be due to concerns of obscuring the diagnosis of appendicitis. In the last decade, evidence disputing this supposition has mounted. No recent studies have described pain management patterns in undifferentiated cases, reasons behind withholding analgesia, or its relationship with surgical consultation. Given a decade of new evidence supporting the safety of analgesia, our objectives were to explore the current practice variation surrounding the provision of analgesia by paediatric emergency physicians, identify reasons for withholding analgesia, and evaluate the relationship of providing analgesia with obtaining surgical consultation. We prospectively surveyed physician members of the Paediatric Emergency Research Canada (PERC) database. We collected demographic information and presented three scenarios depicting undifferentiated abdominal pain of varying severity. A modified Dillman's Tailored Design method was used to distribute the survey, from June 15 to July 16, 2014. Our overall response rate was 75% (149/200). 52% of respondents were female and their mean age was 44 years. Most respondents completed paediatric emergency medicine fellowship training (59%) and were within 15 years of independent practice (74%). The rates of providing analgesia for the cases of renal colic, intussusception, and appendicitis were 100%, 92.1%, and 83.4% respectively, while rates of providing IV opioids were 85.2%, 12.4%, and 58.6% respectively. Across scenarios, all 61 respondents obtaining surgical consultation provided analgesia. Of respondents withholding analgesia, most (21/35 or 60%) believed that pain was not severe enough to warrant it, and only 5/35 (14.3%) indicated that analgesia would obscure a surgical condition. The self-reported rates of analgesic provision for acute undifferentiated pain by paediatric emergency physicians is higher than reported one decade ago and, according to self-report, surgical consultation does not negatively impact the provision of analgesia.