Management of Pain in Children With Acute Otitis Media in Emergency Department [Conference Winner Abstract]

Introduction Biases, misconceptions, and lack of standardized pain assessment lead to inadequate pain assessment and treatment in children. Acute otitis media (AOM), a common childhood infection and key reason for pediatric emergency visits, highlights this problem, with inconsistent pain assessment despite its prevalence and associated discomfort [1]. This study evaluates pain assessment and management in children referred for acute otitis at our pediatric emergency department (PED). Aim This study aimed to evaluate the assessment and management of pain in children referred with acute otitis to our university hospital pediatric emergency department (PED). Methods This single-center, retrospective study was performed in our PED from January 1st to December 31st, 2023. Data of patients presenting with acute otitis media (AOM) were collected from the hospital medical health record system. Children with chronic conditions and previous ear surgeries were excluded. Collected variables: demographics (age, gender), time of arrival, symptoms and their onset, previous consultation (GP, ENT, hospital), previous AOM, vaccinations, otoscopy, lab tests (CRP), hospitalization, treatment (antibiotics, pain killers, off-label). Pain severity was assessed using the Visual Analog Scale (VAS). Data were further stratified by age, symptoms, treatment plan and treatment approach to evaluate trends in pain assessment and management. P value <0.05 was considered statistically significant. Results A total of 223 patients were included, with a median age of 5 years (range: 3-8), and 49.3% were female. The majority (83.9%) were aged between 1 and 12 years. Most children (n=194) arrived at the PED without prior consultation. Symptoms had been present for less than 48 hours in 50.5% of cases, yet only 6.9% were documented as having a fever. The assessment of fever was inconsistent, and its relationship with pain management remained unclear. Pain evaluation was conducted for only 73 patients (32.7%), with 57.5% reporting moderate to severe pain (VAS 4-10). Out of 222 patients, 166 were systematically given painkillers, from whom 137 were not evaluated for pain, and 29 had mild pain (VAS < 4). In 150 patients (67.3%), pain was either not assessed or minimally documented. Conclusions Pain assessments were not systematically conducted for each patient, resulting in 67.3% of cases being unrecorded. Out of 137 patients, there was no documented pain evaluation; however, they still received painkillers, suggesting treatment choices were frequently made without an objective assessment. These findings highlight the need for standardized pain assessment tools to ensure appropriate and evidence-based pain management in pediatric AOM cases.