Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Abstract

Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment. Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmaco-logic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉ Objectifs: L'e ´ tude visait a ` dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et a ` examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi a ` repé rer les sujets e ´ ventuels, et une version modifié e de la Dillman's Total Design Survey Method a e ´ té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse a ` l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins e ´ taient a ˆ gé s de 31 a ` 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingt-quatre pour cent des mé decins ont fait e ´ tat d'une documentation obligatoire sur l'e ´ valuation de la douleur dans leur e ´ tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) e ´ taient souvent prescrits au SU pour le soulagement de la douleur lé gè re ou modé ré e. Plus de la moitié des sondages vé sicaux (60%) et des piqû res intravei-neuses (53%) e ´ taient effectué s sans analgé sie. Les interventions non pharmacologiques les plus courantes chez les nourrissons et les enfants e ´ taient les sucettes et la distraction , respectivement. La formation reç ue et le sexe des mé decins avaient une incidence sur les probabilité s de recours a ` des interventions non pharmacologiques. Les From the