Most children with pain are managed by either acetaminophen or ibuprofen. However, no study has so far investigated if children are prescribed adequate doses of acetaminophen or ibuprofen in emergency department. Aim of this retrospective study was to investigate the prevalence of under-dosage of these drugs in children presenting with pain in emergency department. Children initially prescribed with acetaminophen or ibuprofen for pain management were included. The χ 2 automatic interaction detection method was used considering the percentage variation from the minimum of the appropriate dose as dependent variable while prescribed drug, age, gender, body weight, type of hospital (pediatric or general), and availability of internal guidelines on pediatric pain management in the emergency department as independent variables. Data on 1471 children managed for pain were available. Under-dosage was prescribed in 893 subjects (61%), of whom 577 were prescribed acetaminophen and 316 ibuprofen. The use of acetaminophen suppositories, body weight <12 kg or >40 kg, and the use of oral ibuprofen identified clusters of children associated with under-dosage prescription.
Conclusion: Prescription of acetaminophen and ibuprofen was frequently under-dosed. The use of suppositories, lower and higher body weight, and the use of ibuprofen were associated with under-dosage. Under-dosing may reflect prescription of anti-pyretic doses.
Clinical trial registration : Agenzia Italiana del Farmaco–Observational Study Register (RSO). Registration code: PIERRE/1
What is Known:
• Pain is frequent in children presented to emergency department.
• International recommendations on pain management are often not implemented.
What is New:
• Acetaminophen and ibuprofen were frequently underdosed in children prescribed for pain in the Italian emergency departments.
• Under-dosage may be related to the habit of using acetaminophen and ibuprofen in the recommended range for fever treatment.
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Benini F, Piga S, Zangardi T, Messi G, Tomasello C, Pirozzi N, Cuttini M, PIPER Study Group (2016) Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care. Acta Paediatr 105:e200–e208
Cabana MD, Medzihradsky OF, Rubin HR, Freed GL (2001) Applying clinical guidelines to pediatric practice. Pediatr Ann 30:274–282
Doherty C, Mc Donnell C (2012) Tenfold medication errors: 5 years’ experience at a university-affiliated pediatric hospital. Pediatrics 129:916–924
Felluga M, Rabach I, Minute M, Montico M, Giorgi R, Lonciari I, Taddio A, Barbi E (2016) A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children’s anxiety and pain levels in emergency department. Eur J Pediatr 175:645–650
Ferrante P, Cuttini M, Zangardi T, Tomasello C, Messi G, Pirozzi N, Losacco V, Piga S, Benini F, PIPER Study Group (2013) Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals. BMC Pediatr 13:139
Marzuillo P, Guarino S, Barbi E (2014) Paracetamol: a focus for the general pediatrician. Eur J Pediatr 173:415–425
McCullough HN (1998) Acetaminophen and ibuprofen in the management of fever and mild to moderate pain in children. Paediatr Child Health 3:246–250
Meiri N, Ankri A, Hamad-Saied M, Konopnicki M, Pillar G (2016) The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2–10 years old undergoing venous blood drawing—a randomized controlled study. Eur J Pediatr 175:373–379
Miller JL, Johnson PN, Harrison DL, Hagemann TM (2010) Evaluation of inpatient admissions and potential antimicrobial and analgesic dosing errors in overweight children. Ann Pharmacother 44:35–42
Misurac JM, Knoderer CA, Leiser JD, Nailescu C, Wilson AC, Andreoli SP (2013) Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr 162:1153–1159
Pretorius A, Searle J, Marshall B (2015) Barriers and enablers to emergency department nurses’ management of patients’ pain. Pain Manag Nurs 16:372–379
Ruest S, Anderson A (2016) Management of acute pediatric pain in the emergency department. Curr Opin Pediatr 28:298–304
The authors would also like to thank Dr. Alec Villa for his assistance in the linguistic revision. Furthermore, they would like to thank the PIERRE GROUP STUDY: F Benini, T Zangardi, (Dipartimento di Salute della Donna and del Bambino, Università di Padova, Padua, Italy); A Nocerino, G Crichiutti (Azienda Ospedaliera Universitaria, Udine, Italy); E Barbi, G Messi, A Delise (Istituto Materno Infantile Burlo Garofolo, Trieste, Italy); P Biban, D. Silvagni (Azienda Ospedaliera Universitaria Integrata, Veron, Italy); A Arrighini (Azienda Ospedaliera Spedali Civili PO di Brescia, Italy); AF Podestà, C Scalfaro (Azienda Ospedaliera S. Carlo Borromeo, Milan, Italy); C Stringhi, S Rotta, (ICP PO Buzzi, Milan, Italy); EF Fossali, L Dellera, GP Milani (IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy); E Castagno, A Urbino, (AOU Città della Salute and della Scienza di Torino–Ospedale Infantile Regina Margherita, Turine, Italy); C Marciano, A Ribotti (Azienda Ospedaliera SS Antonio and Biagio and C Arrigo, Alessandria, Italy); L Manfredini, L Piccotti, S Forti (Istituto Giyearsna Gaslini, IRCCS, Genoa, Italy); L Calistri, A Messeri, S Masi (AOU A. Meyer, Florence, Italy); A Chiaretti, Claudia Fantacci (Policlinico Agostino Gemelli, Rome, Italy); F Fucà, R Parrino (Bari ARNAS, Palermo); F Bernardi, I Corsini (Policlinico S.Orsola-Malpighi, Bologna, Italy); MR Govoni, A. Fumarola (Ospedale S. Anna, Ferrara, Italy); S Barca, R Picchi (Azienda Ospedaliera S. Anna, Como, Italy) P Bertolani (Azienda Ospedaliera Universitaria, Modena, Italy).
No external funding for this manuscript.
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Communicated by Mario Bianchetti
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Milani, G.P., Benini, F., Dell’Era, L. et al. Acute pain management: acetaminophen and ibuprofen are often under-dosed. Eur J Pediatr 176, 979–982 (2017). https://doi.org/10.1007/s00431-017-2944-6
- Pain treatment
- Dose errors