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Characterizing Pain in Children with Acute Gastroenteritis Who Present for Emergency Care
Samina Ali1, Claudia Maki2, Jianling Xie3
1Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada.
Insights
Most children with acute gastroenteritis (AGE) experience moderate to severe pain before and during emergency department (ED) visits. Effective pain management strategies are needed for pediatric patients with AGE.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Pain Management
Background:
- Acute gastroenteritis (AGE) is a common pediatric illness presenting to emergency departments (EDs).
- Pain is a significant symptom in children with AGE, impacting their well-being and care.
- Characterizing pain and its management in this population is crucial for improving treatment protocols.
Purpose of the Study:
- To characterize pain experienced by children with acute gastroenteritis (AGE) in the 24 hours before ED presentation.
- To analyze pain during the ED visit, discharge recommendations, and overall analgesic use.
- To identify factors influencing analgesic use and pain severity in pediatric AGE patients.
Main Methods:
- Prospective cohort study involving 2136 children under 18 with AGE across two pediatric EDs.
- Data collected on pain levels before and during ED visits, analgesic administration, and discharge recommendations.
- Statistical analysis to identify factors associated with pain severity and analgesic use.
Main Results:
- The majority of caregivers reported moderate or severe pain for their children before ED presentation (74.8%) and during the ED visit (57.8%).
- Analgesia was administered to 21.2% of patients in the ED, with acetaminophen and ibuprofen being most common.
- Factors associated with increased ED analgesia use included higher pain scores, having a primary care physician, earlier presentation, fewer diarrhea episodes, fever, and hospitalization.
Conclusions:
- Children with AGE frequently experience significant pain both prior to and during emergency department visits.
- Current analgesic use in the ED is relatively low, highlighting a potential gap in pain management.
- Further research is warranted to develop effective, safe, and timely pain management plans for pediatric AGE.
Objective:
To characterize the pain experienced by children with acute gastroenteritis (AGE) in the 24 hours before emergency department (ED) presentation. Secondary objectives included characterizing ED pain, discharge recommendations, overall analgesic use, and factors that influenced analgesic use and pain severity.
Study Design:
A prospective cohort was recruited from 2 pediatric EDs (December 2014 to September 2017). Eligibility criteria included <18 years of age, AGE (≥3 episodes of diarrhea or vomiting in the previous 24 hours), and symptom duration <7 days at presentation.
Results:
We recruited 2136 patients, median age 20.8 months (IQR 10.4, 47.4) and 45.8% (979/2136) female. In the 24 hours before enrollment, most caregivers reported moderate (28.6% [610/2136, 95% CI 26.7-30.5]) or severe (46.2% [986/2136, CI 44.0-48.3]) pain for their child. In the ED, they reported moderate (31.1% [664/2136, 95% CI 29.1-33.1]) or severe ([26.7% [571/2136, 95% CI 24.9-28.7]) pain; analgesia was provided to 21.2% (452/2131). The most common analgesics used in the ED were acetaminophen and ibuprofen. At discharge, these were also most commonly recommended. Factors associated with greater analgesia use in the ED were high pain scores during the index visit, having a primary care physician, earlier presentation to emergency care, fewer diarrheal episodes, presence of fever, and hospitalization at index visit.
Conclusions:
Most caregivers of children presenting to the ED with AGE reported moderate or severe pain, both before and during their visit. Future research should focus on the development of effective, safe, and timely pain management plans.
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