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Analgesia Administration for Acute Abdominal Pain in the Pediatric Emergency Department

Goldman, Ran D. MD*; Crum, Dana BSc*; Bromberg, Rudy BSc*; Rogovik, Alex PhD, MD*; Langer, Jacob C. MD, FRCSC

doi: 10.1097/01.pec.0000195761.97199.37
Original Articles

Objective: To document the use of analgesia for children with acute abdominal pain in the Pediatric Emergency Department (PED) and to compare between children with suspected appendicitis in a high versus low probability.

Study Design: Patients 0-16 years recruited prospectively as part of another PED study in Toronto. History of present illness and physical examination was available, and information on analgesia administered in the PED was retrospectively collected from charts. Physicians' probability of appendicitis before any imaging was recorded. A follow-up call was made to verify final diagnosis.

Results: We included 438 patients, 16% with appendicitis. Analgesics were given 154 times to 112 patients. Thirty-one percent of the cohort received analgesia before seeing the physician, mostly febrile, 37% after seeing the physician, and 17% after seeing a pediatric-surgery consultant. Fifteen percent received multiple dosages. Underdosing was recorded in 14% of medications, mostly morphine (24%). Analgesia was given significantly more often to children with high probability of appendicitis. Age was not a factor in analgesia administration.

Conclusion: Children with abdominal pain receive more analgesia when the physician suspects appendicitis, yet only in half of the cases, and only 15% receive opioids. Opioid underdosing happens in a quarter of times it is given.

*Pediatric Research in Emergency Therapeutics (PRETx) Program, The Division of Pediatric Emergency Medicine, Department of Pediatrics, Population Health Sciences, The Research Institute, The Hospital for Sick Children and †The Division of General Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Ran D. Goldman, MD, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.