78 Nitrous Oxide Use for Children Experiencing Painful Procedures: A Survey of Canadian Paediatric Emergency Physicians’ Knowledge, Attitudes, and Practices
Bibliographic record
Abstract
Abstract Background Nitrous oxide (N2O) is an inhaled analgesic/anxiolytic gas with ample evidence supporting its safety and efficacy in children. However, its prevalence of use remains low, while its indications in paediatric emergency departments (EDs) across Canada remain unknown. Optimization of safe and appropriate of N2O use in this setting requires an understanding of paediatric emergency providers’ knowledge, attitudes, and practice patterns surrounding its use. Objectives We aimed to characterize physicians’ perceptions and current site-specific processes and procedures surrounding N2O use to understand differences between current evidence and clinical practice and standardize care for children undergoing distressing procedures. Design/Methods This cross-sectional survey was distributed electronically to all physician members of Paediatric Emergency Research Canada (PERC) from February to April 2021. Survey items pertained to N2O availability, comfort with N2O use, and perceived barriers/facilitators to its use. Further, a PERC representative from each site completed a site-specific inventory of N2O policies and procedures. Results Response rate was 67.8% (156/230), with 53.2% (83/156) women; 66.6% (104/156) had paediatric emergency subspecialty training, and mean clinical experience was 14.7 years (SD 8.6). 40.0% (6/15) of sites had N2O available in the ED, and 83.3% (5/6) of these institutions had written policies and/or procedures in place for N2O use in the ED. Overall, 48.7% (76/156) of physicians reported using N2O in their clinical practice. The most common indications for use were fracture/dislocation reduction (69.7%, 53/76), wound closure (60.5%, 46/76), and incision and drainage (59.2%, 45/76). The most common perceived barriers to N2O included concerns about ventilation/scavenging systems (71.2%, 57/80) and unfamiliarity with equipment (52.5%, 42/80). The most common perceived facilitators were N2O availability in the ED (73.0%, 114/156) and clinical experience with N2O (71.7%, 112/156). Of the 51.3% (80/156) physicians who reported not using N2O, 93.7% (75/80) did not have access available at their site; notably, 77.3% (58/75) indicated a desire to have access to N2O. Conclusion Despite evidence to support its use, only half of paediatric emergency physicians in Canada currently use N2O as a tool for treating children’s procedure-related pain and distress. Increasing availability of necessary equipment, protocols, and clinical training surrounding N2O use in children may improve clinicians’ abilities to better manage children’s acute pain and distress in the ED, and other clinical contexts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".