scholarly journals Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

CJEM ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 892-902 ◽  
Author(s):  
Caroline Whiston ◽  
Samina Ali ◽  
Bruce Wright ◽  
David Wonnacott ◽  
Antonia S. Stang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Painful Condition ◽  
Major Barrier ◽  
Study Find ◽  
Children's Pain

CLINICIAN’S CAPSULEWhat is known about the topic?Children’s pain in the emergency department (ED) continues to be under-recognized and sub-optimally managed.What did this study ask?We sought to evaluate the frequency of caregiver/child acceptance of analgesia offered in the ED.What did this study find?Of the 743 children who presented to the ED with a painful condition, 408 (54.9%) were offered analgesia. If offered in the ED, analgesia was accepted by 91% (373/408) of the caregivers/children.Why does this study matter to clinicians?This study suggests that caregiver/child refusal of analgesia is a not a major barrier to optimal pain management and highlights the importance of ED personnel in encouraging adequate analgesia.

scholarly journals Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul Owono Etoundi ◽  
Junette Arlette Metogo Mbengono ◽  
Ferdinand Ndom Ntock ◽  
Joel Noutakdie Tochie ◽  
Dominique Christelle Anaba Ndom ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Pain Management ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study

2020 ◽  
pp. archdischild-2020-319173
Author(s):  
Rasha D Sawaya ◽  
Cynthia Wakil ◽  
Sami Shayya ◽  
Moustafa Al Hariri ◽  
Alik Dakessian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Peak Time ◽  
Work Efficiency ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
The Impact

ObjectiveTo investigate the impact of Ramadan on patient characteristics, diagnoses and metrics in the paediatric emergency department (PED).DesignRetrospective cross-sectional study.SettingPED of a tertiary care centre in Lebanon.PatientsAll paediatric patients.ExposureRamadan (June 2016 and 2017) versus the months before and after Ramadan (non-Ramadan).Main outcome measuresPatient and illness characteristics and PED metrics including peak patient load; presentation timings; length of stay; and times to order tests, receive samples and report results.ResultsWe included 5711 patients with mean age of 6.1±5.3 years and 55.4% males. The number of daily visits was 28.3±6.5 during Ramadan versus 31.5±7.3 during non-Ramadan (p=0.004). The peak time of visits ranged from 18:00 to 22:00 during non-Ramadan versus from 22:00 to 02:00 during Ramadan. During Ramadan, there were significantly more gastrointestinal (GI) and trauma-related complaints (39.0% vs 35.4%, p=0.01 and 2.9% vs 1.8%, p=0.005). The Ramadan group had faster work efficiency measures such as times to order tests (21.1±21.3 vs 24.3±28.1 min, p<0.0001) and to collect samples (50.7±44.5 vs 54.8±42.6 min, p=0.03).ConclusionsRamadan changes presentation patterns, with fewer daily visits and a later peak time of visits. Ramadan also affects illness presentation patterns with more GI and trauma cases. Fasting times during Ramadan did not affect staff work efficiency. These findings could help EDs structure their staffing to optimise resource allocation during Ramadan.

scholarly journals Under Prescription of Epinephrine to Medicaid Patients in the Pediatric Emergency Department

2019 ◽  
Vol 6 ◽  
pp. 2333794X1985496
Author(s):  
Sylvia Owusu-Ansah ◽  
Oluwakemi Badaki ◽  
Jamie Perin ◽  
Martha Stevens ◽  
Jennifer Anders ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Considerable Proportion ◽  
Pediatric Emergency Department ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adherence Data ◽  
Auto Injector ◽  
Medicaid Prescription

Objective. To describe pediatric Medicaid patients with pediatric emergency department (PED) visits for anaphylaxis who received epinephrine auto-injector (EAI) prescriptions in the ED versus those who did not; and to compare patients who filled their prescriptions versus those who did not. Methods. We conducted a cross-sectional study of Medicaid patients aged 0 to 21 years presenting to 2 PEDs, with symptoms meeting the National Institute of Allergy and Infectious Diseases criteria for anaphylaxis, between July 2012 and July 2014. Results. We identified 86 patients across the 2 hospitals with a confirmed diagnosis of anaphylaxis in the PED. Of these, 55 (64%, 95% confidence interval [CI] = 53% to 74%) received a prescription for an EAI during their ED visit. Forty-two (68%; 95% CI = 56% to 80%) received a prescription for EAI in Hospital 1 versus 13 (54%; 95% CI = 33% to 74%) in Hospital 2. Medicaid prescription fill rates were available for Hospital 1. Of the 42 who received an EAI prescription, 36 (86%; 95% CI = 75% to 96%) filled these prescriptions with Medicaid. Of the 20 (32%) out of 62 patients with anaphylaxis who did not receive prescriptions for an EAI, only 5 had previously filled prescriptions for epinephrine. Conclusion. Previous Medicaid patient prescription adherence data suggested that these patients would have a low EAI prescription fill rate. We found Medicaid patients who received prescriptions for an EAI after the ED visit for anaphylaxis filled them; however, a considerable proportion of anaphylaxis visits had no EAI prescription provided at discharge.

scholarly journals Knowledge, attitudes, and practices of Cameroonian physicians with regards to pain management at the emergency department: a multicenter cross-sectional study

2019 ◽  
Author(s):  
Paul Owono Etoundi ◽  
Junette Arlette Metogo Mbengono ◽  
Ferdinand Ndom Ntock ◽  
Joel Noutakdie Tochie ◽  
Dominique Christelle Anaba Ndom ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Pain Management ◽  
Acute Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Level Of Knowledge ◽  
Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We carried out a prospective analytic cross-sectional study over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a 30-item structured questionnaire, data on the knowledge, attitudes, and practices of pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

scholarly journals Parental administration of analgesia to children attending the emergency department with acutely painful conditions.

2020 ◽  
Author(s):  
Tessa Kathleen Daly ◽  
Rory O'Brien ◽  
Adrian Murphy
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Pain Score ◽  
Cross Sectional Study ◽  
Emergency Setting ◽  
Educational Strategies ◽  
Cross Sectional ◽  
Major Barrier ◽  
Included Patient ◽  
Analgesic Administration

Background Acute paediatric pain management is often suboptimal in the emergency setting. There is a paucity of published literature on parental administration of analgesia to children, prior to their arrival at the emergency department (ED). The objective of this study was to describe the prevalence of pre-hospital analgesic administration by parents/guardians of children ≤16 years presenting to ED, with acutely painful conditions. Methods This was a prospective cross-sectional study conducted across two EDs in the South of Ireland with a collective annual attendance of approximately 100,000 patients. A consecutive sample of 400 parents/guardians of children aged between 6 months and 16 years, who were self-referred to ED with acutely painful conditions, were included. Data collected included patient demographics, pain score and analgesia administration. Data was analysed with SPSS software using descriptive and inferential statistics. Results 189/400(47%) children received analgesia from their parents/guardians pre-ED arrival. Factors independently associated with increased parental administration of analgesia were: pain score ≥5/10 53.4%(95%CI 48%-59%) vs ≤4/10 29%(95%CI 21%-38%), children with siblings 49.7%(95%CI 45%-56%) vs without siblings 35.3%(95%CI 24%-47%) and presenting <48 hours from onset of pain 50.1%(95%CI 45%-55%) vs presenting ≥48 hours 30.5%(95%CI 19%-42%). Of the 400 participants, 211(53%) received no analgesia before attending ED. Reasons for parents not administering analgesia included: 62/211(29.4%) did not think the child needed it, 39/211(18.5%) accident did not happen at home, 34/211(16.1%) did not want to mask the presence of the pain, 20/211(9.5%) believed the hospital should give medications, and 18/211(8.5%) afraid it would be wrong/harmful. Conclusions Over half the children presenting to ED, with acutely painful conditions, did not receive adequate or timely pain relief pre-ED arrival, causing avoidable suffering. Parental misconceptions about acute pain management are major barrier to analgesic administration. Educational strategies are required to dispel misconceptions, which may ultimately improve the care for this population.

scholarly journals Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

2019 ◽  
Author(s):  
Paul Owono Etoundi ◽  
Junette Arlette Metogo Mbengono ◽  
Ferdinand Ndom Ntock ◽  
Joel Noutakdie Tochie ◽  
Dominique Christelle Anaba Ndom ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Pain Management ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Level Of Knowledge ◽  
Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We cross-sectional study carried out prospectively over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a validated and pretested structured questionnaire, data on the knowledge, attitudes, and practices of acute pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

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