Pain Management in the Emergency Department: Patterns of Analgesic Utilization

Objective. To compare the use of analgesia in children to adultsin 3 different emergency department (ED) settings. Methods. Forty adultand 40 pediatricED charts were randomly selected for review at each of 3 institutions: an academic medical center with separate pediatricand adultEDs (SEP ED), a community academic medical center with a combined adultand pediatricED (COMB ED), and a community hospitalwith 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, analgesicuse and dosing in the ED and on discharge, and time from triage to analgesicuse. Results. The mean pediatricand adultages 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%). Pediatricpatients (64/120; 53%) received significantly less analgesia in the ED than adultpatients (88/120; 73%). This difference was significant at the COMB ED ( pediatric23/40; 58% vs adult35/40; 88%) and COMTY ED ( pediatric15/40; 38% vs adult26/40; 65%), but not at the SEP ED ( pediatric26/40; 65% vs adult27/40; 68%). 195/240 (81%) patients received discharge pain medication. There were no differences between pediatric(93/120; 78%) and adult(102/120; 85%) discharge analgesicprescribing practices. Although there was no difference in appropriateness of analgesicdoses in the ED, pediatricpatients (20/74; 27%) were more likely than adultpatients (3/88; 3%) to receive inadequate doses of analgesicson discharge from the ED. Conclusions. ED analgesia continues to be used less frequently in the pediatriccompared with the adultpopulation. Inadequate dosing of discharge analgesicmedication in children is a significant problem. Patterns of analgesicutilization may differ in different types of ED settings.