Williams Kevin, Saeed Noor, Ihnow Stephanie, Mangeot Colleen, Denning Jaime
Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA.
Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
Cureus. 2022 Aug 31;14(8):e28632. doi: 10.7759/cureus.28632. eCollection 2022 Aug.
Objectives Currently, very little literature exists regarding the "fifth vital sign" in pediatric orthopedics, pain. Multiple studies have highlighted the utility of non-narcotic pain medications in treating acute pain. The objective of this study is to determine the type and amount of pain medication(s) administered and subsequently prescribed to pediatric patients ages six months to five years old with femur fractures treated with spica casting in the ER (emergency room) and OR (operative room). We also determined the incidence of spica cast change necessary for the two groups as a secondary outcome. Methods A retrospective review was completed at a single level 1 pediatric trauma center, evaluating 82 patients who met the inclusion criteria between six months to five years of age with isolated femoral shaft fractures requiring intervention at one institution. Descriptive statistics and Wilcoxon Rank-Sum or Fisher'sFisher's Exact test were used to assess differences between OR and ER groups for either continuous or categorical variables, respectively. The electronic medical record was then queried for demographic information, location of spica cast placement, hours in the hospital, and amount and type of analgesic medications administered and prescribed. Results Overall, we noted a preponderance of femur fractures in young males (72%), with the mean age of our cohort being 2.3 years old. Our patients spent a median of 20.9 hours in the hospital and had a median worst pain score of 7/10 during their hospital stay. No difference was found between standardized amounts of morphine equivalent administration between groups in the hospital. Upon discharge from the hospital, most patients received opioid and acetaminophen prescriptions (72% and 83%), but few received an ibuprofen prescription (24.4%). More spica casts placed in the ER needed to be revised in the OR compared to spica casts placed in the OR (57% vs. 8%, p<0.01). Conclusions There are various medication regimens for patients with femoral shaft fractures treated with spica casting at one institution. Our study revealed that patients received more prescription opioids if treated in the OR. Additionally, spica casting in the ER did not significantly decrease hospital stay, and it significantly increased the risk of needing a reduction in the OR in our institution.
目的 目前，关于小儿骨科中的“第五生命体征”——疼痛的文献非常少。多项研究强调了非麻醉性镇痛药在治疗急性疼痛方面的效用。本研究的目的是确定在急诊室（ER）和手术室（OR）接受髋人字石膏固定治疗的6个月至5岁股骨骨折小儿患者所使用及随后开具的镇痛药的类型和剂量。我们还将两组髋人字石膏更换的发生率作为次要结果进行了测定。方法 在一家一级小儿创伤中心完成了一项回顾性研究，评估了82例年龄在6个月至5岁之间、符合纳入标准、在同一机构因孤立性股骨干骨折需要干预的患者。分别使用描述性统计以及Wilcoxon秩和检验或Fisher精确检验来评估OR组和ER组在连续变量或分类变量上的差异。随后查询电子病历以获取人口统计学信息、髋人字石膏固定位置、住院时长以及所使用和开具的镇痛药的剂量和类型。结果 总体而言，我们发现年轻男性股骨骨折占多数（72%），我们队列的平均年龄为2.3岁。我们的患者住院时间中位数为20.9小时，住院期间疼痛最严重程度评分中位数为7/10。两组在医院内吗啡等效剂量的标准化给药量方面未发现差异。出院时，大多数患者收到了阿片类药物和对乙酰氨基酚的处方（分别为72%和83%），但很少有人收到布洛芬处方（24.4%）。与在手术室放置的髋人字石膏相比，在急诊室放置的髋人字石膏在手术室需要修订的更多（57%对8%，p<0.01）。结论 在同一机构，对于接受髋人字石膏固定治疗的股骨干骨折患者有多种药物治疗方案。我们的研究表明，如果在手术室接受治疗，患者会收到更多的阿片类药物处方。此外，在急诊室进行髋人字石膏固定并没有显著缩短住院时间，并且在我们机构中显著增加了在手术室进行复位的风险。
