Prevalence of analgesic refusal and reasons for refusal among children and parents in the pediatric emergency department.

Analgesic refusal in the emergency department can be a barrier to optimal pain management. This study aimed to quantify the prevalence of analgesic refusal among pediatric patients and their caregivers in this setting and to explore possible determinants and rationale for such refusal. This cross-sectional observational study was conducted at a tertiary-level pediatric emergency department in Italy from July to December 2023. A questionnaire was offered to children presenting with moderate to severe pain and their parents, collecting amnestic and clinical data. In case of analgesic refusal, the questionnaire asked for the reason. The primary outcome was the prevalence of analgesic refusal. Among 799 children with moderate to severe pain, 116 children refused the analgesia, yielding an overall refusal rate of 18.3%. Children with moderate pain, pain duration of 12-24 h, and those triaged as minor urgencies were significantly more likely to refuse analgesia. Conversely, children with severe pain, acute pain (< 12 h), and those triaged as urgent cases were more likely to accept analgesia. The main reason for refusing analgesia was that the perceived pain intensity was not severe enough to warrant pharmacological intervention. There were no significant differences in the characteristics of caregivers who accepted or refused analgesia.  Conclusions: This study found a high prevalence of pharmacological analgesia refusal in children presenting to the emergency department. Most refusals were due to the perception that the pain intensity was not severe enough to require pharmacological interventions. What is Known: • Pain is a primary reason for Emergency Department (ED) visits in children. • Analgesic refusal can be seen as a barrier to optimal pain management in this setting. • No European studies have explored the prevalence of analgesic refusal in children and the reasons for refusal. What is New: • This study found an 18.3% prevalence of analgesic refusal among children with moderate to severe pain. • Children's age, as well as the type and duration of pain, are variables associated with refusal. • Caregiver characteristics do not significantly influence the rate of refusal. • The primary reason for refusing analgesia was the perceived intensity of pain, supporting the notion that a simple numerical pain assessment may not accurately reflect a child's willingness to undergo pharmacological intervention.