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Emergency department analgesic use in pediatric trauma victims with fractures
1Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH.
Insights
Emergency department analgesic use was low in children with fractures, particularly those with head injuries. Further research is needed to explore appropriate pain management for these pediatric trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Pain Management
Background:
- Pediatric patients with fractures risk associated injuries.
- Assessing analgesic use in pediatric trauma is crucial.
Purpose of the Study:
- Investigate emergency department (ED) analgesic administration frequency in children with fractures at risk for multiple injuries.
- Identify factors influencing analgesic prescription in this population.
Main Methods:
- Retrospective review of a computerized trauma registry.
- Analysis of 99 pediatric patients meeting trauma team activation criteria with specific fracture types.
- Data included prehospital and ED care phases.
Main Results:
- 53% of children received analgesics (all narcotics).
- Head injury was associated with significantly lower analgesic use (31% vs. 62%).
- No other factors distinguished analgesic vs. no-analgesic groups.
Conclusions:
- ED analgesic use is low in mildly to moderately injured children with fractures.
- Head injury is linked to reduced analgesic administration.
- Further investigation is warranted to optimize pain management in pediatric trauma.
Study Objective:
To investigate the frequency of emergency department analgesic use in children with presumably painful fractures who are also at risk for associated multiple injuries and to determine whether there are specific factors that distinguish those who are prescribed analgesics from those who are not.
Design:
Descriptive, retrospective review of a computerized trauma registry.
Setting:
Regional pediatric ED and trauma center.
Participants:
Four hundred thirty-three injured children met trauma team activation criteria from January 1, 1991 through June 30, 1992. Of these 433, we selected the 121 children who had fractures of the pelvis, long bones, ankle, wrist, or clavicle. Of these 121, we excluded the 22 children who underwent endotracheal intubation. Trauma registry data from the prehospital and ED phases of care from the remaining 99 children were reviewed for this study.
Interventions:
None.
Main Results:
Of the study group, 53% (52 of 99) received analgesics, all narcotics. Excluding the 46 children with multi-system injuries, only 62% (33 of 53) received analgesics. Patients in both the analgesic (52) and no-analgesic groups (47) were mildly to moderately injured based on initial ED trauma scores and vital signs. No statistical or clinical significant differences were found between the analgesic group and the no-analgesic group when comparing age, sex, race, mechanism of injury, vehicle speed, height of fall, time elapsed from injury until arrival at the ED, transport method, prehospital analgesic use, mortality, Injury Severity Score, and initial ED vital signs, Glasgow Coma Scale, Trauma Score, and Pediatric Trauma Score. Fifty-nine percent (ten of 17) of the children with associated internal injuries limited to the chest or abdomen received analgesics compared with 62% (33 of 53) in those with isolated fracture (P = .8). Those with an associated head injury (31%, nine of 29) received analgesics less frequently than those with isolated fracture (62%, 33 of 53) (P = .01).
Conclusion:
Our results suggest that ED analgesic use was low in these mildly to moderately injured children with presumably painful fractures who are also at risk for associated multiple injuries. Head injury was associated with especially low analgesic use. We did not identify other specific factors that distinguished those who received analgesics from those who did not. Further investigation is required to determine if after the initial evaluation, a larger proportion of mildly to moderately injured trauma victims with fractures are appropriate candidates for ED analgesic use.