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Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department
Jennifer Noble1, Bradley Zarling2, Thomas Geesey3
1Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Twenty-eight percent of pediatric patients with long bone fractures (LBFs) received no pain medication, particularly during typical emergency department volumes. Further research is needed on pain management strategies for LBFs.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Orthopedic Injuries
Background:
- Significant practice variations exist in managing pain for pediatric long bone fractures (LBFs).
- Understanding current pain management practices is crucial for improving patient care.
Purpose of the Study:
- To describe current pain management strategies for children with LBFs.
- To identify factors associated with undertreatment of pain in this population.
Main Methods:
- Retrospective study of 905 children (0-18 years) with LBFs in a pediatric emergency department (PED) from November 2015 to August 2016.
- Data collected included demographics, injury characteristics, and PED crowding using the National Emergency Department Overcrowding Scale.
- Analysis focused on time to pain assessment, analgesia administration, and factors influencing treatment.
Main Results:
- 72% of children received analgesia, with ibuprofen being most common. Median time to pain score was 6 minutes, but median time to analgesia order was 63 minutes.
- No factors were associated with overall undertreatment (oligoanalgesia).
- Narcotic undertreatment was linked to African-American race, public insurance, and private vehicle arrival; ambulance arrival and lower extremity fractures were associated with timely analgesia.
Conclusions:
- A significant proportion (28%) of children with LBFs did not receive pain medication, especially during normal PED volumes.
- Further research is recommended to explore triage as a potential setting for timely analgesia delivery for LBFs.
Background:
Practice variation exists in pain management of children with long bone fractures (LBFs).
Objective:
The objectives of this study were to describe current pain management in children with LBFs and the factors associated with the undertreatment of pain.
Methods:
We retrospectively studied children (aged 0-18 years) with a diagnosis of LBF in a pediatric emergency department (PED) from November 2015 through August 2016. Demographic characteristics and quality measures were noted. We determined the impact of PED crowding using the National Emergency Department Overcrowding Scale.
Results:
A total of 905 patients (63% male, 48% African American) were enrolled. Median age was 6 years (interquartile range [IQR] 7 years), 72% had upper extremity injuries, falls were the most common mechanism (74%), and the majority were discharged (77%). Median time to pain score was 6 min (IQR 14 min). Seventy-two percent received analgesia with a median time to order of 63 min and medication receipt of 87 min. Ibuprofen was the analgesia prescribed most commonly. There were no identified factors associated with oligoanalgesia. Nonuse of narcotics was associated with African-American race, public insurance, single fractures, and arrival via private vehicle. Ambulance arrivals, lower extremity fractures, and disaster mode were associated with receiving analgesia within 60 min.
Conclusions:
In our study, 28% of children with LBFs did not receive pain medications, especially during normal PED volumes. Additional studies are required to explore triage as a venue for analgesia delivery for LBFs.
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