Pain management in the emergency department: patterns of analgesic utilization.

OBJECTIVE: To compare the use of analgesia in children to adults in 3 different emergency department (ED) settings.

METHODS: Forty adult and 40 pediatric ED charts were randomly selected for review at each of 3 institutions: an academic medical center with separate pediatric and adult EDs (SEP ED), a community academic medical center with a combined adult and pediatric ED (COMB ED), and a community hospital with a combined ED (COMTY ED). All patients presenting to the EDs from July 1993 to June 1994 within 12 hours of an isolated long bone fracture were eligible for inclusion. Data were collected on demographics, training of providers, analgesic use and dosing in the ED and on discharge, and time from triage to analgesic use.

RESULTS: The mean pediatric and adult ages were 8.7 and 38.3 years, respectively. Overall, 152/240 (63%) patients received some form of analgesia in the ED, with the COMTY ED (41/80; 51%) offering significantly less analgesia than the COMB ED (58/80; 73%), but not the SEP ED (53/80; 66%). Pediatric patients (64/120; 53%) received significantly less analgesia in the ED than adult patients (88/120; 73%). This difference was significant at the COMB ED (pediatric 23/40; 58% vs adult 35/40; 88%) and COMTY ED (pediatric 15/40; 38% vs adult 26/40; 65%), but not at the SEP ED (pediatric 26/40; 65% vs adult 27/40; 68%). 195/240 (81%) patients received discharge pain medication. There were no differences between pediatric (93/120; 78%) and adult (102/120; 85%) discharge analgesic prescribing practices. Although there was no difference in appropriateness of analgesic doses in the ED, pediatric patients (20/74; 27%) were more likely than adult patients (3/88; 3%) to receive inadequate doses of analgesics on discharge from the ED.

CONCLUSIONS: ED analgesia continues to be used less frequently in the pediatric compared with the adult population. Inadequate dosing of discharge analgesic medication in children is a significant problem. Patterns of analgesic utilization may differ in different types of ED settings.