Acute pediatric musculoskeletal pain management in North America: a practice variation survey
Janeva Kircher1, Amy L Drendel2, Amanda S Newton3
1University of Alberta, Edmonton, Alberta, Canada.
Insights
Pain management for children
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Orthopedics
- Pain Management
Background:
- Acute musculoskeletal (MSK) pain in children presents a significant challenge in pediatric care.
- Current practices for managing pediatric MSK pain require further investigation to identify areas for improvement.
Purpose of the Study:
- To assess the current analgesia administration practices for acute pediatric MSK pain.
- To evaluate discharge advice provided to patients with acute pediatric MSK pain.
- To identify factors influencing the choice of analgesics in pediatric MSK pain management.
Main Methods:
- A survey was distributed to pediatric emergency physicians and orthopedic surgeons.
- The survey collected data on analgesia administration in the emergency department and at discharge.
- 683 responses were analyzed to understand current practices and influencing factors.
Main Results:
- Ibuprofen was the most frequently reported analgesic for both emergency department use (52%) and discharge (68%).
- Oral opioids were used by 85% of respondents in the prior 6 months, with codeine being the most common (ED: 38%, home: 51%).
- Analgesic choice varied significantly based on pain severity, child's age, and physician experience/specialty, with younger physicians and recent graduates favoring acetaminophen and codeine.
Conclusions:
- Significant heterogeneity exists in the selection of analgesics for pediatric MSK pain.
- Physician characteristics, patient age, and pain severity are key determinants of analgesic choice.
- Further research and standardized guidelines may be beneficial for optimizing pediatric MSK pain management.
Abstract:
Children's musculoskeletal (MSK) injury pain remains poorly managed. This survey of pediatric emergency physicians and orthopedic surgeons assessed analgesia administration practices and discharge advice for children with acute MSK pain; 683 responses were received. Ibuprofen was the most commonly reported analgesic used in the emergency department (52%) and at discharge (68%). Most (85%) reported using oral opioids in the previous 6 months. Codeine use was the most commonly reported opioid used in the emergency department (38%) and at home (51%). For equal levels of pain, younger children received less opioids than older children. Younger physicians and recent graduates chose acetaminophen and codeine more than older and more experienced colleagues, who preferred ibuprofen and non-codeine containing opioid compounds (P < .001 and .006, respectively). Orthopedic surgeons reported less ibuprofen use than pediatric emergency physicians (P < .001). Choice of analgesic agents is heterogeneous among physicians and is influenced by pain severity, child's age, and physician characteristics.
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