191: Pediatric Pain Management: the Emergency Medicine Residents' Perspectives

Abstract

Introduction: Pain is a component of up to 80% of all emergency department (ED) visits. Oligoanalgesia, the under-treatment of pain, is a recognized problem in the ED and can have numerous detrimental effects for the pediatric patient. Surveying emergency medicine residents, our primary objectives were to describe the extent and type of training received, management approach to common painful pediatric presentations, level of comfort in assessing and treating acute pain, perceived facilitators and barriers to optimally managing pain, and attitudes towards managing such pain in the ED. Methods: A descriptive, cross-sectional survey was administered to all Royal College Emergency Medicine, Pediatric Emergency Medicine, and Canadian College of Family Physician's EM trainees at three universities. A novel survey tool was created and distributed from May to June 2013. Surveys were completed online, using a modified Dillman approach. Results: Our response rate was 46% (56/122). Forty-five percent (25/55) of residents had not received any training in pediatric pain assessment. All years of residents reported they were uncomfortable with the assessment of pain in 0-2 year olds (p=0.07); for patients aged 2-12 years, level of comfort with pain assessment increased with years of training (p=0.02). When assessing pain in children with disabilities, 83% (45/54) of residents were 'extremely' or 'somewhat' uncomfortable and 65% (47/55) of residents had not received any training on how to assess their pain. Sixty nine percent (38/55) of residents had received training on how to treat pediatric pain. All residents were more comfortable using pain medication for a 9 year old, as compared to a 1 year old (oral oxycodone p=0.00003, oral morphine p=0.00002, IV morphine p=0.004). Ninety-eight percent (54/55) of residents felt that it was 'extremely' or 'somewhat' important to receive education about pediatric pain. The preferred methods to learn children's pain management were role modeling (61%) and lectures (57%). Challenges to optimal pediatric pain management were non-verbal, disabled, and young children. Conclusion: Pediatric pain management education is important to Canadian EM residents. Residents recall receiving sub-optimal training on this important topic. They are especially uneasy in the management of younger children and those with disabilities. This study's findings can be used to inform post-graduate curriculum planning, in order to optimize pediatric pain assessment and treatment education.