scholarly journals Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 199-203 ◽  
Author(s):  
Naveen Poonai ◽  
Victoria Brzozowski ◽  
Antonia S. Stang ◽  
Amy L. Drendel ◽  
Philippe Boisclair ◽  
...  
Keyword(s):  
Pain Management ◽  
Primary Outcome ◽  
Management Practices ◽  
Young Infant ◽  
Pediatric Emergency ◽  
Emergency Physicians ◽  
Emergency Research ◽  
Canadian Association ◽  
Secondary Outcomes ◽  
Specific Barriers

AbstractObjectivesLumbar 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.MethodsWe 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.ResultsFor 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%).ConclusionCompared 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.

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

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 352-360 ◽  
Author(s):  
Samina Ali ◽  
Andrea Chambers ◽  
David W. Johnson ◽  
Amanda S. Newton ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Pain Management ◽  
Management Practices ◽  
Pediatric Emergency ◽  
Practice Variation ◽  
Further Education ◽  
Survey Method ◽  
Emergency Physicians ◽  
Pain Medications ◽  
And Gender ◽  
Almost All

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 nonpharmacologic 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.

scholarly journals Endotracheal Intubation Using a Direct Laryngoscope and the Protective Performances of Respirators: A Randomized Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Taeho Lim ◽  
Sanghyun Lee ◽  
Jaehoon Oh ◽  
Hyunggoo Kang ◽  
Chiwon Ahn ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Primary Outcome ◽  
Intubation Time ◽  
Emergency Physicians ◽  
Invasive Procedures ◽  
Direct Laryngoscope ◽  
Fold Type ◽  
Secondary Outcomes ◽  
Protective Performance ◽  
Randomized Crossover Study

Purpose. Emergency physicians are at risk for infection during invasive procedures, and the respirators can reduce this risk. This study aimed to determine whether endotracheal intubation using direct laryngoscopes affected protection performances of respirators. Methods. A randomized crossover study of 24 emergency physicians was performed. We performed quantitative fit tests using respirators (cup type, fold type without a valve, and fold type with a valve) before and during intubation. The primary outcome was respirators’ fit factors (FF), and secondary outcomes were acceptable protection (percentage of scores above 100 FF [FF%]). Results. 24 pieces of data were analyzed. Compared to fold-type respirator without a valve, FF and FF% values were lower when participants wore a cup-type respirator (200 FF [200-200] versus 200 FF [102.75–200], 100% [78.61–100] versus 74.16% [36.1–98.9]; all P<0.05) or fold-type respirator with a valve (200 FF [200-200] versus 142.5 FF [63.50–200], 100% [76.10–100] versus 62.50% [8.13–100]; all P<0.05). There were no significant differences in intubation time and success rate according to respirator types. Conclusions. Motion during endotracheal intubation using direct laryngoscopes influenced the protective performance of some respirators. Therefore, emergency physicians should identify and wear respirators that provide the best personalized fit for intended tasks.

scholarly journals Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians – CORRIGENDUM

CJEM ◽  
2018 ◽  
Vol 21 (5) ◽  
Author(s):  
Naveen Poonai ◽  
Victoria Brzozowski ◽  
Antonia S. Stang ◽  
Amy L. Drendel ◽  
Philippe Boisclair ◽  
...  
Keyword(s):  
Pain Management ◽  
Management Practices ◽  
Emergency Physicians

scholarly journals The appropriateness of referrals to a pediatric emergency department via a telephone health line

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 139-148 ◽  
Author(s):  
Tawfik Al-Abdullah ◽  
Amy C. Plint ◽  
Alyson Shaw ◽  
Rhonda Correll ◽  
Isabelle Gaboury ◽  
...  
Keyword(s):  
Emergency Department ◽  
Resource Use ◽  
Primary Outcome ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Lengths Of Stay ◽  
Triage Category ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Explicit Criteria

ABSTRACT Objective: We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral. Methods: A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED. Results: Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p &lt; 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes. Conclusion: There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.

scholarly journals Trends in use in a Canadian pediatric emergency department

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 405-410 ◽  
Author(s):  
Quynh Doan ◽  
Emerson D. Genuis ◽  
Alvis Yu
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Ed Overcrowding ◽  
Secondary Outcomes ◽  
Ed Crowding

ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

scholarly journals External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023214 ◽  
Author(s):  
Ariane Ballard ◽  
Christelle Khadra ◽  
Samara Adler ◽  
Evelyne D Trottier ◽  
Benoit Bailey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Analogue Scale ◽  
Primary Outcome ◽  
Study Groups ◽  
Psychological Consequences ◽  
Institutional Review ◽  
Registration Number ◽  
Secondary Outcomes ◽  
Randomised Controlled

IntroductionNeedle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department.Methods and analysisThis study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority.Ethics and disseminationThis study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberNCT02616419.

Fractures in the Pediatric Emergency Department: Are We Considering Abuse?

2018 ◽  
Vol 57 (10) ◽  
pp. 1161-1167 ◽  
Author(s):  
Lindsay R. Lavin ◽  
Cody H. Penrod ◽  
Cristina M. Estrada ◽  
Donald H. Arnold ◽  
Benjamin R. Saville ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Pediatric Emergency ◽  
Primary Objective ◽  
Predictor Variables ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Pediatric Emergency Department ◽  
Emergency Physicians ◽  
Primary Outcome Variable

Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric emergency department clinicians consider abuse in infants with fractures. Our primary objective was to estimate the percentage of infants with fractures for whom abuse was considered, and to examine characteristics associated with abuse consideration. We performed a retrospective review of infants <1 year of age presenting to a pediatric emergency department. Our primary outcome variable was consideration of abuse. Our secondary outcome measures were identification of predictor variables associated with consideration of abuse. We identified 509 infants meeting study criteria. Pediatric emergency physicians considered abuse in approximately two thirds of infants with fractures. Consideration was more likely to occur in younger infants, in the presence of no history or unwitnessed injury mechanism, when evaluated by male physicians, and emergency department encounters from 12 am to 6 am.

Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study

2009 ◽  
Vol 25 (8) ◽  
pp. 498-503 ◽  
Author(s):  
Sylvie Le May ◽  
C. Celeste Johnston ◽  
Manon Choinière ◽  
Christophe Fortin ◽  
Denise Kudirka ◽  
...  
Keyword(s):  
Pain Management ◽  
Emergency Room ◽  
Management Practices ◽  
Pediatric Emergency

scholarly journals Use of personal protective equipment in Canadian pediatric emergency departments

CJEM ◽  
2011 ◽  
Vol 13 (02) ◽  
pp. 71-78 ◽  
Author(s):  
Sarah M. Reid ◽  
Ken J. Farion ◽  
Kathryn N. Suh ◽  
Tobey Audcent ◽  
Nicholas J. Barrowman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Infection Control ◽  
Personal Protective Equipment ◽  
Early Identification ◽  
Pediatric Emergency ◽  
Protective Equipment ◽  
Pediatric Emergency Medicine ◽  
Emergency Physicians ◽  
Emergency Research ◽  
Knowledge Based

ABSTRACT Objective: Numerous barriers to maintaining infection control practices through the use of personal protective equipment (PPE) exist in the emergency department (ED). This study examined the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs. Methods: A self-administered survey instrument consisting of 21 questions was developed and piloted for this study. The survey was mailed to all individuals listed in the Pediatric Emergency Research Canada database of physicians practicing pediatric emergency medicine in Canada. Results: A total of 186 physicians were surveyed, and 123 (66%) participated. Twenty-two percent of participants reported that they had never received PPE training and 32% had not been trained in the previous 2 years. Fifty-three percent reported being very or somewhat comfortable with their knowledge of transmission-based isolation practices. Participants were correct on a mean of 4.9 of 11 knowledge-based questions (SD 1.7). For scenarios assessing self-reported use of PPE, participants selected answers that reflected PPE use in accordance with national infection control standards in a mean of 1.0 of 6 scenarios (SD 1.0). Participants reported that they would be more likely to use PPE if patients were clearly identified prior to physician assessment, equipment was accessible, and PPE use was made a priority in their ED. Conclusions: Knowledge and self-reported adherence to recommended infection control practices among Canadian pediatric emergency physicians is suboptimal. Early identification of patients requiring PPE, convenient access to PPE, and improved education regarding isolation and PPE practices may improve adherence.

scholarly journals Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study

2021 ◽  
pp. 102490792110333
Author(s):  
Chi-Kit Sin ◽  
Bun Young
Keyword(s):  
Direct Laryngoscopy ◽  
Primary Outcome ◽  
Foreign Bodies ◽  
Flexible Endoscopy ◽  
Interquartile Range ◽  
Emergency Physicians ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
Secondary Outcomes ◽  
Difficulty Score

Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p < 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.

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