Analgesic Administration in the Pediatric Emergency Department for Patients with Isolated Long-Bone Fractures
Jennifer Noble1, Brad Zarling2, Thomas Geesey2, Erich Smith2, Walid Yassir1, Ahmad Farooqi2, Usha Sethuraman1
1Children's Hospital of Michigan, Detroit, MI;2Wayne State University, Detroit, MI
Background (issue): Describe analgesia utilization during the pediatric emergency department (PED) visit and assess factors associated with analgesia use in patients with isolated long-bone fractures (LBFX).
Methods: This retrospective study of patients aged 0 to 18 years with a diagnosis of an isolated LBFX was conducted at a level 1 PED from November 2015 through August 2016. Pain score was evaluated pre and post analgesia using non-parametric sign test. Chi-square test was used to assess factors associated with analgesia. Demographic variables were evaluated using descriptive statistics. PED crowding used the National Emergency Department Overcrowding Scale.
Findings: 905 patients with long-bone fractures were included. 63% were male between 5-12 years (56%) with Medicaid (73%) who had upper extremity (72%) injuries secondary to falls (74%) that were splinted (58%) and discharged (77%). Most patients received an initial pain score (98%). 72% patients received analgesia with a median time to analgesia of 87 minutes. Patients (81%) were re-evaluated after analgesia was given and there was a significant decrease in pain score p<0.0001. Non-use of narcotics was associated with children <2 years p<0.004, African Americans p<0.0001 and Medicaid p<0.0003. The time to analgesia increased as the ED overcrowding score increased. Parent feedback scores correlate with whether pain medication was given with only 34% of parents being satisfied with their child's pain control.
Conclusions (implications for practice): Analgesia for long bone fractures in children presenting to the ED is still poor, especially in African Americans and children < 2 years of age. Future quality improvement projects on analgesia for LBFX should focus on these groups.
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