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Emergency Department Pain Management in Children With Appendicitis in a Biethnic Population

Jacob, Ron MD*; Krauss, Baruch MD; Twito, Gal BSc; Leiba, Ronit MA§; Shavit, Itai MD*

doi: 10.1097/AJP.0000000000000485
Original Articles

Objectives: 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

R.J.: acquisition of the data; designed the study and the analysis plan, analyzed and interpreted the data; and critically revised the manuscript for important intellectual content. B.K.: analyzed and interpreted the data, and critically revised the manuscript for important intellectual content. G.T.: acquisition of the data, and critically revised the manuscript for important intellectual content. R.L.: carried out the statistical analysis, analyzed and interpreted the data, and critically revised the manuscript for important intellectual content. I.S.: designed the study and the analysis plan, drafted the manuscript, and analyzed and interpreted of the data.

The authors declare no conflict of interest.

Reprints: Itai Shavit, MD, Emergency Department, Ruth Children’s Hospital, Rambam Health Care Campus. P.O. Box 274, Kibutz Maayan Tzvi, Hof Hacarmel Regional Council, 3080500, Israel (e-mail: itai@pem-database.org).

Received October 26, 2016

Received in revised form January 25, 2017

Accepted January 27, 2017

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