*Department of Pediatrics,University of Calgary,Calgary,AB.
†Department of Pediatrics,University of Alberta,Edmonton,AB.
CJEM. 2017 Nov;19(6):417-423. doi: 10.1017/cem.2016.391. Epub 2016 Nov 30.
Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs).
A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision.
A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years. Sixty-one percent (381/616) of patients received analgesia in the ED; 42.8% (264/616) received IV morphine. Other analgesic agents provided included oral acetaminophen (23.5% [145/616]) and oral ibuprofen (5.8% [36/616]). The median (IQR) initial dose of IV morphine was 0.06 (0.04, 0.09) mg/kg. The median (IQR) time from triage to the initial dose of analgesia was 196 (101, 309.5) minutes. Forty-three percent (117/269) of children receiving analgesia received the initial dose following surgical consultation; 43.7% (121/277) received their first analgesic after abdominal ultrasound was performed.
Suboptimal and delayed analgesia remains a significant issue for children with suspected appendicitis in Canadian PEDs. This suggests a role for multidimensional knowledge translation interventions and care protocols to improve timely access to analgesia.
患有疑似阑尾炎的儿童存在疼痛管理效果欠佳的风险。本研究旨在描述加拿大儿科急诊部（PED）中疑似阑尾炎患儿的疼痛管理模式。
本研究对加拿大 12 个 PED 进行了回顾性病历审查。2010 年 2 月或 10 月，年龄在 3 至 17 岁之间、因疑似阑尾炎而住院的患儿被纳入研究。如果患儿在其他医院仅接受部分评估或治疗，则将其排除。使用特定的标准化电子数据提取工具提取数据。主要结局是在急诊部（ED）接受镇痛治疗的患儿比例。次要结局包括接受静脉（IV）吗啡的患儿比例和镇痛药物提供的时间。
共提取了 619 份健康记录；患者的平均（SD）年龄为 11.4（3.5）岁。61%（381/616）的患儿在 ED 接受了镇痛治疗；42.8%（264/616）接受了 IV 吗啡。此外，还使用了其他镇痛药物，包括口服对乙酰氨基酚（23.5% [145/616]）和口服布洛芬（5.8% [36/616]）。IV 吗啡初始剂量的中位数（IQR）为 0.06（0.04，0.09）mg/kg。从分诊到首次使用镇痛药物的中位数（IQR）时间为 196（101，309.5）分钟。接受镇痛治疗的患儿中，43%（117/269）在接受外科会诊后首次使用镇痛药物；43.7%（121/277）在进行腹部超声检查后首次使用镇痛药物。
在加拿大 PED 中，疑似阑尾炎患儿的镇痛效果欠佳和延迟仍然是一个严重的问题。这表明需要采取多维知识转化干预措施和护理方案，以改善及时获得镇痛的机会。
