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.
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.
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
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.