Is fever treated more promptly than pain in the pediatric emergency department?

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).

Keywords: acetaminophen; acuity; database; electronic medical record; emergency department; fever; ibuprofen; pain; pediatric; triage.