Is Fever Treated More Promptly Than Pain in the Pediatric Emergency Department?

Ronald Dvorkin, MD; Jacob Bair, DO; Hardik Patel, MBBS; Sanford Glantz, MD; David P. Yens, PHD; Anthony Rosalia Jr., MD; Jeffrey Marguilies, MD

Disclosures

J Emerg Med. 2014;46(3):327-334. 

In This Article

Abstract and Introduction

Abstract

Background: Fever can be treated with a higher priority than pain in the pediatric emergency department (ED) population.

Objective: The primary objective was to assess whether patients with a fever are treated with acetaminophen or ibuprofen more promptly than they are treated for pain.

Methods: A retrospective descriptive study was performed on all patients between the ages of 3 and 19 years who received acetaminophen or ibuprofen in the pediatric ED from February 1, 2010 to January 31, 2011. The time interval from arrival to treatment with acetaminophen or ibuprofen was compared for those patients with a fever (≥100.4°F) and those without a fever and had reported pain. Other measurable points (time of vital signs, bed assignment, and medication order) on the medical record were compared to further describe any differences.

Results: Pediatric patients with fever (n = 1097) received ibuprofen or acetaminophen a median of 54.0 min (interquartile range [IQR], 35.4−89.3 min) after arrival. The corresponding median time for afebrile patients (n = 1861) that received the same medications was 83.2 min (IQR, 52.7−136.1). The difference between medians was 24.6 min (95% confidence interval 21.3−27.9 min).

Conclusions: Fever is treated more promptly than pain in the pediatric ED. This difference is associated with prevailing and largely unfounded concerns about fever and the undertreatment of pain (oligoanalgesia).

Introduction

Pain is often not treated promptly or adequately in the emergency department (ED).[1] Lack of adequate pain management has been referred to as oligoanalgesia. Withholding of analgesics of any type does not obscure evaluation of patient and clinical diagnosis.[2] We were specifically interested in the time of delivery of the noncontrolled analgesics, acetaminophen and ibuprofen, to pediatric patients.

There is no evidence to indicate that lowering a child's moderate temperature elevation improves clinical outcome, and there is evidence that prompt treatment of pain may be beneficial.[3–6] In a January 2010 pilot study, data obtained from routine chart reviews demonstrated that patients with fever obtained acetaminophen or ibuprofen more promptly than patients with pain. We wished to compare any time differences to the delivery of the same antipyretic and analgesic medications between febrile and afebrile patients.

The primary objective was to compare the time from patient arrival to the administration of acetaminophen or ibuprofen for patients with a temperature ≥100.4°F with those patients with a temperature <100.4°F. Other measurable points (time of vital signs, bed assignment, and medication order) on the medical record were also examined to further describe any differences. A separate analysis to determine the individual effects of temperature, pain, age, and acuity on the time to treatment was also performed.

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