Acetaminophen dose accuracy and pediatric emergency care.

Abstract

To describe the demographic and clinical characteristics of children who receive acetaminophen per emergency department standing orders and identify factors associated with supratherapeutic doses (>or=16 mg/kg). A cross-sectional retrospective study of consecutive children who received acetaminophen at an urban children's hospital emergency department. Over a 1-week period, 156 (24%) of 661 emergency department children were treated with acetaminophen. Of the children receiving acetaminophen, 64 (41%) were less than 2 years and 92 (59%) were males. The indication for acetaminophen was fever in 140 (90%) children, and 70 (50%) had temperatures >or=39degreesC. The route of administration was oral [133 (85%)] and rectal [23 (15%)]. There were 122 (78%) correct doses (standing order dose range of 10 to 15 mg/kg), 15 (10%) doses of <10 mg/kg, and 19 (12%, 95% CI, 8% to 18%) doses of >or=16 mg/kg. In comparison, children who received acetaminophen at normal or low doses (<16 mg/kg) versus supratherapeutic doses (>or=16 mg/kg) showed a significant difference in route. The rate of rectal route was significantly greater in the supratherapeutic doses (95% CI for changes in proportion, 14% to 48%). Review of acetaminophen dose accuracy, particularly the rectal route, is recommended for emergency departments with standing orders for acetaminophen.