In a turn-around of conventional medical practice, the AAP announced study results that demonstrate that relief of abdominal pain in children need not interfere with diagnostic accuracy.
The blinded study was conducted at the Children's Hospital of
Wisconsin, in Milwaukee, and presented at the
combined annual meeting of the Pediatric Academic Societies and the
American Academy of Pediatrics.
Children from age 5 to 18 who were admitted to the
emergency department with severe abdominal pain, were randomly
assigned to receive either 0.1 mg/kg morphine or saline intravenously for
pain relief. Before the morphine or placebo was injected, the surgical residents and attending surgeons on duty examined the child and made a preliminary diagnosis. Fifteen minutes after injection, the same physicians examined the patient again and made another diagnosis. Both before and after the injection, the young patients were asked to rate the severity of their pain.
The study group was small, but the data conclusive. Among the 47 patients evaluated over 17 months, Dr. Kim found that all 13 surgical conditions in the morphine group were correctly diagnosed by both the residents and the supervising physicians. "The most critical factor was not to miss a patient who required surgery," Dr. Kim pointed out.
Morphine made no difference in the location of palpation or
percussion tenderness, but it did significantly reduce the amount of pain
reported by the patients. Further, there were no complications were reported from administering morphine.
The findings of this study are consistent with earlier reports that morphine
can be administered to adults without compromising the accuracy of the
final diagnosis, Dr. Kim added.