Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan.
Department of Orthopedic Surgery, Detroit Medical Center, Detroit, Michigan.
J Emerg Med. 2020 Mar;58(3):500-505. doi: 10.1016/j.jemermed.2019.09.018. Epub 2019 Nov 16.
Practice variation exists in pain management of children with long bone fractures (LBFs).
The objectives of this study were to describe current pain management in children with LBFs and the factors associated with the undertreatment of pain.
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.
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.
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.
儿童长骨骨折（LBF）的疼痛管理存在实践差异。
本研究旨在描述儿童 LBF 疼痛管理的现状，并探讨与疼痛治疗不足相关的因素。
我们回顾性研究了 2015 年 11 月至 2016 年 8 月期间在儿科急诊部（PED）就诊的 LBF 患儿（年龄 0-18 岁）。记录人口统计学特征和质量指标。使用国家急诊部过度拥挤量表评估 PED 拥挤程度的影响。
共纳入 905 例患儿（63%为男性，48%为非裔美国人）。中位数年龄为 6 岁（四分位距 [IQR] 7 岁），72%为上肢损伤，最常见的损伤机制是跌倒（74%），大多数患儿出院（77%）。疼痛评分中位数时间为 6 分钟（IQR 14 分钟）。72%的患儿接受了镇痛治疗，中位镇痛医嘱下达时间为 63 分钟，药物送达时间为 87 分钟。布洛芬是最常开的镇痛药。未发现与少镇痛相关的因素。非阿片类药物的使用与非裔美国人种族、公共保险、单一骨折和私家车就诊有关。救护车到达、下肢骨折和灾难模式与 60 分钟内接受镇痛治疗有关。
在我们的研究中，28%的儿童 LBF 未接受疼痛药物治疗，尤其是在 PED 正常量时。需要进一步研究以探讨分诊作为 LBF 镇痛治疗的场所。
