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Article
Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians.
Canadian Journal of Emergency Medicine
  • Naveen Poonai, Western University
  • Victoria Brzozowski, Western University
  • Antonia S Stang
  • Amy L Drendel
  • Philippe Boisclair
  • Michael Miller, Western University
  • Stuart Harman
  • Samina Ali
Document Type
Article
Publication Date
3-1-2019
URL with Digital Object Identifier
https://doi.org/10.1017/cem.2018.382
Disciplines
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.

Notes

Also available open access in Canadian Journal of Emergency Medicine at https://doi.org/10.1017/cem.2018.382

Citation Information
Naveen Poonai, Victoria Brzozowski, Antonia S Stang, Amy L Drendel, et al.. "Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians." Canadian Journal of Emergency Medicine Vol. 21 Iss. 2 (2019) p. 199 - 203
Available at: http://works.bepress.com/naveen-poonai/21/