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Pain score documentation and analgesia: A comparison of children and adults with appendicitis


  • Michelle Sumner, MB BS, BEc, BJapS, Emergency Medicine Registrar; Jeremy Furyk, MB BS, FACEM, Staff Specialist.

Dr Michelle Sumner, Department of Emergency Medicine, The Townsville Hospital, Angus Smith Drive, Douglas, PO Box 670, Townsville, Qld 810, Australia. Email:


Objective:  There is a growing body of evidence suggesting that administration of analgesia in paediatric ED is inadequate. The present study was designed to assess pain score documentation and provision of opioid analgesia to children and adults with confirmed appendicitis in a mixed Australian ED.

Method:  A retrospective chart review of all adults and children with histologically confirmed appendicitis diagnosed in the Townsville ED during 2006 was performed. Data collected included pain score documentation, weight, opioid dose, oral analgesia, time of presentation, level of doctor and prehospital analgesia.

Results:  Data were collected for 106 adults and 39 children. Among them, 13 (33%) children compared with 79 (75%) adults had a pain score documented (OR 0.16, 95% CI 0.07–0.37, P < 0.001). And 11 (28%) children compared with 79 (75%) adults received i.v. morphine (OR 0.13, 95% CI 0.06–0.31, P < 0.001). Administration of oral analgesia lowered the likelihood and pain score documentation increased the likelihood of receiving morphine in both children and adults.

Conclusion:  Documentation of pain scores and provision of i.v. morphine is generally poor. Children are less likely than adults to have a pain score documented, or receive i.v. morphine when presenting with appendicitis.