Emergency Department Pain Management in Children With Appendicitis in a Biethnic Population. Issue 11 (November 2017)

• Record Type: Journal Article
• Authors: Jacob, Ron; Krauss, Baruch; Twito, Gal; Leiba, Ronit; Shavit, Itai
• Is Part Of: Clinical journal of pain. Volume 33:Issue 11(2017)
• Publication Date: 2017-11
• Subjects: emergency -- pain -- appendicitis -- ethnicity; Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesia -- Periodicals; 616.047205
• DOI: 10.1097/AJP.0000000000000485
• Languages: English
• ISSNs: 0749-8047

Abstract

Abstract : Objectives: Our goal was to examine factors associated with the administration of emergency department analgesia (any analgesia, opioid analgesia) in patients with acute appendicitis in a tertiary children's hospital in Israel, and to examine ethnic differences. Methods: A retrospective cohort study of children evaluated in the emergency department, who had International Classification Of Disease—Ninth Revision (ICD-9) diagnosis of acute appendicitis. Regression analysis was used to test the effect of multiple variables on the provision of analgesia. Medications were administered according to a nurse-driven pain protocol. Multivariate regression was performed to estimate the strength of association between ethnicity and provision of analgesia. The effect of patient-nurse ethnicity concordance was assessed. Results: During the 6-year study period, there were 715 children with acute appendicitis, 457 Jews and 258 Arabs. Overall, 289 (40.4%) received some form of analgesia, and 139 (19.4%) received opioid analgesia. Univariate analysis revealed that higher pain score ( P <0.001) and higher triage acuity ( P <0.001) were associated with administration of any type of analgesia and of opioid analgesia. When adjusted for age, weight, sex, triage category, pain score, and 24-hour time of arrival, Jewish and Arab patients had similar likelihood of receiving analgesia of any type 41.8% (95% confidence interval [CI], 40.3%-43.3%) versus 40.7% (95% CI, 38.7%-42.8%), and receiving opioid analgesia 26.1% (95% CI, 24.4%-27.8%) versus 25.3% (95% CI, 22.9%-27.7%). Similar proportions of Jewish and Arab patients received analgesia from Jewish and Arab nurses. Conclusions: Low rates of analgesia and opioid administration were found with no ethnic differences. Abstract : Supplemental Digital Content is available in the text.