TOP 14 - Evaluation of the Efficacy of Current Analgesic Prescription Practices in Managing Pain in Pediatric Extremity Fractures After Discharge from the Pediatric Emergency Department

Publication Number: 4716.TOP 14

Jessica Pathrose, John R. Oishei Children's Hospital, Buffalo, NY, United States; Matthew Wiese, John R. Oishei Children's Hospital, Buffalo, NY, United States; Scott Bouton, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Orchard Park, NY, United States; Heather Territo, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States

Background: Fractures are one of the most common causes of pediatric ED visits. Over the last 25 years, several studies have shown that current analgesic practices are often suboptimal in addressing acute pain for these patients. Additional studies have evaluated the efficacy and patient impact of different analgesic agents, with special emphasis on multimodal approach including the use of opioids where appropriate.

However, the ongoing opioid crisis has impacted current practice as providers elect to rely primarily on non-opioid medications for pain management in children with fractures after ED discharge. Previous studies have shown that greater than one third of pediatric patients with fractures, had clinically meaningful pain in this timeframe, a significant subset of whom had fractures requiring manual reduction. Commonly prescribed acetaminophen and ibuprofen alone may not provide adequate pain control for fracture pain in the acute phase which occurs in the first 48-72 hours after injury. This has led to patients seeking additional evaluation and further use of resources to further manage pain.

Objective: The study aims to investigate how well current ED prescribing practices manage pain in pediatric patients with extremity fractures. We hypothesize that children with more complex injuries, such as displaced fractures requiring manipulation under sedation or multiple doses of opioid analgesia within the emergency department, experience suboptimal pain control when managed with standard non-opioid analgesic regimens.

Design/Methods: This is a single site, observational study of children aged 4-18 years with extremity fractures who were discharged from the ED within a 16-month period. Families who consented were contacted by telephone 3-5 days post-discharge to assess the adequacy of pain control and parental perception of the efficacy of over-the -counter at achieving appropriate pain control.

Descriptive characteristics will be applied to categorize patients based on adequacy of pain control. Logistic regression modeling will be performed to assess associations between pain control and demographics or injury related factors. Preliminary data analysis with a sample of 120 patients does demonstrate that 59% of pediatric patients had adequate pain control. Data collection and analysis are ongoing.