Pain Management in Children With Suspected Appendicitis in the Pediatric Emergency Department

Abdominal pain is a common presenting symptom in the pediatric emergency department (ED), with appendicitis being the most common surgical emergency. Administration of analgesia, including opioids, has not been shown to delay the diagnosis of appendicitis, yet oligoanalgesia remains a common occurrence. We aimed to determine the proportion of any analgesia and opioid analgesia administration, the median time to first analgesia administration, and to identify factors associated with the administration of any analgesia and opioid analgesia in patients with suspected appendicitis.

We conducted a single-center cross-sectional study of children less than 18 years of age evaluated in the pediatric ED from June 2014 to June 2021 for suspected appendicitis. Deidentified data were extracted from the electronic record through a data repository. Our primary outcomes were the administration of analgesia and the median time to first analgesia administration. We used descriptive statistics and multivariate regression analysis to compare independent influences on analgesia administration.

During the 8-year study period, 7065 children were evaluated for appendicitis. Overall, 4821 (68.2%) received some form of analgesia, 3157 (44.7%) received nonopioid analgesia only, and 1664 (23.6%) received opioid analgesia during their ED visit. Overall median time to first analgesia was 104 minutes. Median time to first nonopioid analgesia and first opioid analgesia was 94.5 minutes and 136 minutes, respectively. Moderate and severe pain scores, fever, tachycardia, and higher ESI level of acuity were significantly associated with analgesia administration.

Analgesia administration in children with suspected appendicitis varies considerably. Efforts to target more consistent and timely pediatric pain management practices are needed.