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Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review
Sylvie Le May1, Samina Ali2, Christelle Khadra3
1Faculty of Nursing, University of Montreal, Montreal, QC, Canada H3T 1A8; CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5.
Insights
Effective pain management for pediatric musculoskeletal injuries remains challenging due to varied treatments. Further research is needed to establish optimal analgesic strategies for children in emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Musculoskeletal Injury Management
- Pain Therapeutics
Background:
- Pain management for pediatric musculoskeletal injuries is often suboptimal.
- Lack of evidence-based guidelines leads to significant variation in treatment.
- Children presenting to emergency departments require effective pain relief strategies.
Purpose of the Study:
- To systematically review the most effective pain management interventions for children with musculoskeletal injuries in the emergency department.
- To identify optimal pharmacological and nonpharmacological approaches.
- To assess the efficacy of different analgesics and administration routes.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) in electronic databases.
- Inclusion criteria: children aged 0-18 years with musculoskeletal injury in the emergency department.
- Primary outcome: risk ratio for successful pain score reduction.
Main Results:
- Eight studies involving 1169 children (3-18 years) met inclusion criteria.
- Significant heterogeneity in analgesics and routes of administration complicated comparisons.
- Most studies showed similar pain reduction; one favored ibuprofen over acetaminophen. Two serious adverse events were reported.
Conclusions:
- Optimal analgesics cannot be recommended for all pain categories due to treatment heterogeneity.
- Larger trials are required to evaluate analgesics, particularly combinations (nonopioid/opioid) or nonpharmacological interventions.
- Evidence-based guidelines for pediatric emergency pain management are needed.
Abstract:
Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0-18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.
