Poorly Controlled Pediatric Fracture Pain Requiring Unplanned Medical Assistance or Advice

Area of Science:

• Pediatric Orthopedics
• Pain Management
• Child Health

Background:

• Fracture pain in children can be poorly controlled, leading to distress and additional medical consultations.
• Understanding the factors influencing help-seeking behavior is crucial for effective pain management in pediatric orthopedic patients.

Purpose of the Study:

• To determine the percentage of children seeking help for inadequately managed fracture pain.
• To identify factors associated with children seeking unscheduled medical advice for pain.
• To explore caregivers' attitudes and preferences regarding opioid use for pediatric fracture pain.

Main Methods:

• A study involving 251 children (aged 5-17) and their caregivers in a pediatric orthopedic clinic.
• Eligibility criteria included recent single-extremity, nonoperative long bone fractures.
• The primary outcome measured was seeking unscheduled evaluation or advice for pain before the first routine follow-up.

Main Results:

• 7.3% of children sought unscheduled care for poorly controlled pain, primarily for analgesic dosage information or stronger medication.
• Risk factors included leg fractures, overriding/translated fractures, and procedural sedation needs.
• Children with higher pain scores and anxious caregivers were more likely to seek help. One-third of caregivers expressed opioid hesitancy due to addiction concerns.

Conclusions:

• A substantial proportion of children require assistance for uncontrolled fracture pain.
• Discharge instructions should be tailored to identified risk factors.
• Shared decision-making with caregivers is essential when considering opioid therapy.