Underuse of analgesia in very young pediatric patients with isolated painful injuries

Study objective: We sought to compare the use of analgesic agents in very young children with that in older children with isolated painful injuries.
Methods: We performed a retrospective chart review of patients seen between 1999 and 2000 in a pediatric emergency department. Patients aged 6 months to 10 years who sustained isolated long bone fractures or second- and third-degree burns were included. Exclusion criteria included head injury, chest or abdominal trauma, and developmental delay or neurologic disorder. Research subjects were separated into 2 study groups: very young (ages 6 to 24 months) and school age (ages 6 to 10 years).
Results: One hundred eighty research subjects met the inclusion and exclusion criteria: 96 in the very young group and 84 in the school age group. Research subjects in the very young group received no analgesic agents more often than school age research subjects for all injuries (64.6% versus 47.6%, respectively), all fractures (70.6% versus 48.8%, respectively), displaced fractures (55.0% versus 22.0%, respectively), and all burns (50.0% versus 25.0%, respectively). When analgesic agents were administered, very young patients were less likely to receive narcotics compared with school age patients. Analgesic dosing for both the very young and school age groups was similar and within established guidelines.
Conclusion: Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions. Emergency physicians should consider special issues involved in assessing and managing pain in very young children.
[Ann Emerg Med. 2003;41:617-622.]

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From the Department of Emergency Medicine, Maine Medical Center, Portland, ME (Alexander), and the University of Massachusetts Medical School, Worcester, MA (Manno).
Received for publication January 20, 2002.
Revisions received July 18, 2002; September 24, 2002; October 15, 2002; and December 14, 2002.
Accepted for publication January 3, 2003.
Presented at the American College of Emergency Physicians Research Forum, Chicago, IL, October 2001.
The authors report this study did not receive any outside funding or support.
Address for reprints: John Alexander, MD, Department of Emergency Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102; 207-842-7010, fax 207-842-7025; E-mail alexajo@mmc.org
doi:10.1067/mem.2003.138
0196-0644/2003/$30.00 + 0

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