Objective: To describe the demographic and clinical characteristics of children who receive acetaminophen per emergency department standing orders and identify factors associated with supratherapeutic doses (≥16 mg/kg).
Methods: A cross-sectional retrospective study of consecutive children who received acetaminophen at an urban children's hospital emergency department.
Results: 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 ≥39°C. 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 ≥16 mg/kg. In comparison, children who received acetaminophen at normal or low doses (<16 mg/kg) versus supratherapeutic doses (≥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%).
Conclusions: Review of acetaminophen dose accuracy, particularly the rectal route, is recommended for emergency departments with standing orders for acetaminophen.