(273) Pediatric visits to the emergency department for chronic pain

Abstract

Patients and families seek treatment in Emergency Departments (ED) for chronic pain when in crisis. The purpose of this study was to describe the prevalence of ED visits for pediatric chronic pain conditions and pain treatments used during these visits. Data for this secondary analysis were obtained from the Pediatric Health Information System (PHIS) administrative database of inpatient, ED, ambulatory surgery and observation encounter-level data from 49 US children’s hospitals. Data from ED visits coded for chronic pain (excluding sickle cell disease) from January 1, 2012 to December 31, 2015 were analyzed. During the 4-year study period, 24 hospitals had data reported for the entire study period. Included hospitals reported a total of 531 ED visits for 512 patients < 18 years of age with chronic pain. The 4-year trend shows visits have increased over time, few patients (n=6) have >1 visit to the same ED each year, and hospital admission from the ED for chronic pain is rare. Analgesic administration steadily increased from 80 to 90% of visits. However, opioid administration decreased, with < 30% of pediatric patients diagnosed with chronic pain receiving opioids in the ED. The CDC reports increasing use of opioids to treat adults with chronic pain conditions; whereas these data indicate decreasing use of opioids to treat pediatric chronic pain conditions in the ED. PHIS data does not include non-pharmacologic pain treatments used in the ED or what was prescribed for patients upon ED discharge. Despite these limitations, we conclude that pediatric patients with chronic pain are likely to receive a non-opioid analgesic when pain crisis leads them to seek treatment in the ED. Increasing use of the ED for treatment of pediatric chronic pain conditions suggests the need to increase the availability of multidisciplinary pediatric chronic programs in the US.