Evaluación y Tratamiento del Dolor en Urgencias

Multicenter registry studies show pain is documented in only approximately 25-50% of pediatric emergency department cases

Improving pediatric pain management requires institutional culture change and quality improvement methodology, not just additional education

Pain assessment scales validated in calm research settings perform poorly in the chaotic emergency department environment, especially for children under 5 years of age

Both families and healthcare professionals systematically underestimate children's pain severity compared to child self-report on validated scales

Pain assessment should be integrated as a mandatory vital sign at triage, similar to temperature, heart rate, and blood pressure

Pain documentation rates are higher for traumatic injuries than for non-traumatic medical conditions in pediatric emergency departments

Pediatricians have better integrated pain management protocols for trauma cases but struggle with non-traumatic presentations where diagnostic uncertainty exists

Traditional surgical teaching held that analgesia before evaluation would mask diagnostic findings in acute abdomen, though this has been challenged

Multimodal analgesia protocols should be established that allow pain treatment independent of definitive diagnosis

The intranasal route provides systemic absorption comparable to intravenous administration while avoiding first-pass hepatic metabolism

Lipophilic medications (fentanyl, ketamine) are ideal for intranasal administration due to excellent absorption across nasal mucosa

Maximum intranasal volume should not exceed 5 milliliters per nostril for effective absorption

Studies show intranasal ketorolac is non-inferior to opioids for moderate pain in pediatric patients

In some Latin American countries, opioid availability is restricted to inpatient or palliative care settings, not available for emergency department use

When pediatricians do prescribe opioids, evidence indicates they tend to use doses below recommended levels