Delaney Kristen M, Pankow Alexis, Avner Jeffrey R, Rabiner Joni E
From the *Department of Pediatrics, Division of Pediatric Emergency Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; †Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Bellevue Hospital/New York University School of Medicine, New York; and ‡Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY.
Pediatr Emerg Care. 2016 Sep;32(9):581-4. doi: 10.1097/PEC.0000000000000573.
The primary objective of the study was to compare analgesia-prescribing practices and timing of analgesia administration between pediatric emergency medicine (PEM) and general emergency medicine (GEM) practitioners for children with appendicitis. The secondary objective was to compare analgesia administration versus triage pain score, pediatric appendicitis score (PAS), and body mass index (BMI).
This was a retrospective chart review of patients younger than 21 years who presented to either an urban pediatric emergency department (ED) or 2 general EDs and were diagnosed with appendicitis.
Two hundred eighteen charts were reviewed, 153 (70%) from the pediatric ED and 65 (30%) from the general EDs. The patients seen by PEM physicians were younger than the patients seen by GEM physicians (mean age, 12.8 vs 15.4 years; P = 0.002). The patients evaluated by GEM physicians were more likely to receive analgesia in the ED (82% vs 60%, P = 0.003) and received analgesia sooner (mean, 178 vs 239 minutes; P = 0.026) than the patients evaluated by PEM physicians. The patients with triage pain scores higher than 6 of 10 were more likely to receive analgesia than the patients with pain scores lower than 6 (71% vs 51%, P = 0.015). There was no association between PAS or BMI and analgesia administration or time to analgesia (P = not significant).
The patients with appendicitis evaluated by GEM physicians were more likely to receive analgesia and receive analgesia quicker than the patients evaluated by PEM physicians. The patients with higher pain scores were more likely to receive analgesia, but PAS and BMI did not affect analgesia administration.
本研究的主要目的是比较儿科急诊医学（PEM）和普通急诊医学（GEM）从业者对阑尾炎患儿的镇痛处方做法及镇痛给药时间。次要目的是比较镇痛给药情况与分诊疼痛评分、小儿阑尾炎评分（PAS）和体重指数（BMI）之间的关系。
这是一项对年龄小于21岁、前往城市儿科急诊科（ED）或两家普通急诊科就诊并被诊断为阑尾炎的患者的回顾性病历审查。
共审查了218份病历，其中153份（70%）来自儿科急诊科，65份（30%）来自普通急诊科。PEM医生诊治的患者比GEM医生诊治的患者年龄更小（平均年龄，12.8岁对15.4岁；P = 0.002）。与PEM医生诊治的患者相比，GEM医生评估的患者在急诊科接受镇痛治疗的可能性更大（82%对60%，P = 0.003），且接受镇痛治疗的时间更早（平均178分钟对239分钟；P = 0.026）。分诊疼痛评分高于10分制6分的患者比疼痛评分低于6分的患者更有可能接受镇痛治疗（71%对51%，P = 0.015）。PAS或BMI与镇痛给药或镇痛时间之间无关联（P = 无显著性差异）。
与PEM医生评估的阑尾炎患者相比，GEM医生评估的患者更有可能接受镇痛治疗且接受治疗的速度更快。疼痛评分较高的患者更有可能接受镇痛治疗，但PAS和BMI并不影响镇痛给药。
