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Characterizing Pain in Children with Acute Gastroenteritis Who Present for Emergency Care - 22/03/21

Doi : 10.1016/j.jpeds.2020.12.029 
Samina Ali, MDCM 1, 2, 3, 4, , Claudia Maki, BN 3, Jianling Xie, MD, MPH 5, Bonita E. Lee, MD, MSc 1, 3, 4, James Dickinson, MBBS, PhD 6, Shannon E. MacDonald, PhD, RN 1, 3, 4, 7, 8, 9, Naveen Poonai, MD, MSc 10, Jennifer Thull-Freedman, MD 11, 12, 13, Otto Vanderkooi, MD 14, Manasi Rajagopal, MBT 1, 3, Mithra Sivakumar, BN 1, 3, Linda Chui, PhD 15, 16, 17, Timothy A.D. Graham, MD, MSc 2, 3, Alberto Nettel-Aguirre, PhD, PStat 6, Lawrence W. Svenson, PhD 18, Stephen B. Freedman, MDCM, MSc 11, 12, 13
on behalf of

the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE Team) and Pediatric Emergency Research Canada (PERC)

1 Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada 
2 Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada 
3 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada 
4 Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada 
5 Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada 
6 Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 
7 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada 
8 School of Public Health, University of Alberta, Edmonton, Alberta, Canada 
9 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada 
10 Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada 
11 Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 
12 Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 
13 Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 
14 Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 
15 Provincial Laboratory for Public Health, Alberta, Canada 
16 Alberta Public Health Laboratories-ProvLab, Alberta, Canada 
17 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada 
18 Alberta Health, Government of Alberta, Edmonton, Alberta, Canada 

Reprint requests: Dr Samina Ali, MDCM, Department of Pediatrics, 3-583 Edmonton Clinic Health Academy, 11405–87 Ave, Edmonton, Alberta T6G 1C9, CanadaDepartment of Pediatrics3-583 Edmonton Clinic Health Academy11405–87 AveEdmontonAlbertaT6G 1C9Canada

Abstract

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.

Le texte complet de cet article est disponible en PDF.

Key words : distress, analgesia, vomiting, diarrhea, emergency department, pediatrics

Abbreviations : ACH, AGE, ED, SCH, VNRS


Plan


 Funded in part by the Alberta Provincial Pediatric EnTeric Infection TEam, which is supported by an Alberta Innovates Collaborative Research Innovation Opportunity (CRIO). Alberta Provincial Pediatric EnTeric Infection TEam is also supported by the Alberta Children's Hospital Research Institute (Calgary, Alberta) and the Women and Children's Health Research Institute Partnership Award (Edmonton, Alberta). S.F. is supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness. The authors declare no conflicts of interest.
 Portions of this study were presented at the Canadian Paediatric Society 96th Annual Conference, June 6-8, 2019, Toronto, Ontario; and the Canadian Association of Emergency Physicians Annual Meeting, May 26-29, 2019, Halifax, Nova Scotia.


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Vol 231

P. 102 - avril 2021 Retour au numéro
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