Faculty Collaboration Database

Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians. CJEM 2019 Mar;21(2):199-203

Date

05/24/2018

Pubmed ID

29789038

DOI

10.1017/cem.2018.382

Scopus ID

2-s2.0-85063222838 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVES: Lumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient and provider-specific barriers.

METHODS: We surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from May 1 to August 1, 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs.

RESULTS: For a 3-week old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 [100%] of pediatric EPs and 261/262 [99.6%] of general EPs) and a 3-year-old (142/144 [98.6%] of pediatric EPs and 256/262 [97.7%] of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%).

CONCLUSION: Compared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.

Author List

Poonai N, Brzozowski V, Stang AS, Drendel AL, Boisclair P, Miller M, Harman S, Ali S, Pediatric Emergency Research Canada (PERC)

Author

Amy L. Drendel DO Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anesthetics, Local
Canada
Child
Child, Preschool
Clinical Competence
Emergency Medicine
Humans
Infant
Pain
Practice Patterns, Physicians'
Spinal Puncture
Surveys and Questionnaires
Visual Analog Scale