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J Pediatr. 2019 Apr 4. pii: S0022-3476(19)30267-7. doi: 10.1016/j.jpeds.2019.02.035. [Epub ahead of print]

Low Usage of Analgesics for Pediatric Concussion-Related Pain in US Emergency Departments Between 2007 and 2015.

Author information

1
Department of Pediatrics, Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
2
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Edmonton, Alberta, Canada.
3
Department of Pediatrics, Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: brett.burstein@mail.mcgill.ca.

Abstract

OBJECTIVE:

To estimate the proportion of pediatric patients with a concussion who received analgesia when presenting with pain to US emergency departments, and to describe the analgesics used.

STUDY DESIGN:

This was a repeated cross-sectional analysis study using the National Hospital Ambulatory Medical Care Survey database of nationally representative emergency department visits from 2007 to 2015. We included children under 18 years old with isolated concussions. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with analgesic administration.

RESULTS:

There were an estimated 1.54 million isolated concussion visits during the 9-year study period. Pain at presentation was reported frequently (78%), with the majority rated as moderate (36%) or severe (27%). Among all children reporting pain, 42% received no analgesics, including 40% with moderate-to-severe pain intensity. Multivariable analysis found younger age, male sex, and treatment in a nonacademic hospital were all negatively associated with analgesic administration. The medications most frequently administered were acetaminophen (54%), nonsteroidal anti-inflammatories (44%), and opioids (13%).

CONCLUSIONS:

Analgesic medications seem to be underused in the treatment of pediatric concussion-related pain. Following acetaminophen and nonsteroidal anti-inflammatories, opioids, which are not recommended for this condition, were the most frequently prescribed analgesics. Further research should establish optimal, consistent, and responsible pain management strategies for pediatric concussions.

KEYWORDS:

analgesia; opioids; post-traumatic headache

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