Model of Fein et al for Predicting Use of a Topical Anesthetic Agent Before Insertion of an Intravenous Catheter in a Pediatric Patient in the Emergency Department

 

Type of local anesthetic employed: eutectic mixture of local anesthetics (EMLA)

 

Supposition: The time between triage and starting an IV in a patient is > 60 minutes. A child identified as probably needing an IV can have the topical anesthetic applied at the time of triage.

 

Parameters:

(1) medical history

(2) chief complaint

(3) nurses opinion

 

Parameter	Finding	Points
medical history	high risk	2
	not high risk	0
chief complaint	upper respiratory infection (URI) and/or cough	-1
	fever	0
	seizures	1
	gastrointestinal	1
	cellulitis or abscess	2
	referred to ED by physician	2
	other	0
nurse's opinion	not needed	0
	needed	2

 

where:

• High risk history (see Table 2 with asterisks) items: cardiac disorder, oncologic disorder, HIV infection, endocrine, metabolic, neurologic/neuromuscular, gastrointestinal, hematologic or recent tonsillectomy. It does not include constipation, chronic abdominal pain, or gastroesophageal reflux.

• The age of the child was scored 0 points if < 1 year of age, and apparently 0 points if >= 1 year.

• Gastrointestinal complaints include nausea or vomiting, diarrhea, abdominal pain, and gastrointestinal infection.

• It appears that an intravenous line was started primarily to rehydrate the patient or to administer antibiotics.

• There are 2 ways to score chief complaint: (1) consider multiple complaints; (2) allow for only 1.

 

subscore for objective predictors =

= (points for medical history) + (points for chief complaint)

 

total score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum total score: -1

• maximum total score: 6

• A score >= 2 indicated a patient who probably will need an IV and who should be considered for use of a topical anesthetic.

 

Performance at cutoff >=2:

• Sensitivity was 74-76% and specificity 84-86%.