29 - Treatment of Pain in Pediatric Long Bone Fractures- Does it Differ in General and Pediatric Emergency Departments?

Poster Number: 29
Publication Number: 29.405

Aubri Carman, University of Texas at Austin Dell Medical School, Austin, TX, United States; Mark S. Zocchi, Brandeis University, Arlington, MA, United States; Coburn Allen, University of Texas at Austin Dell Medical School, Austin, TX, United States; Corrie E. Chumpitazi, Baylor College of Medicine, Houston, TX, United States; Matthew Wilkinson, UT Austin Dell Medical School, Austin, TX, United States

Background: Most American children still receive emergency care outside of specific pediatric emergency departments (PEDs). Injuries are a common pediatric complaint treated in general emergency departments (GEDs), and many of the most common injuries are long bone fractures. Timely pain assessment and management are important benchmarks included in pediatric readiness and facility recognition.

Objective: To evaluate pain medication administration patterns in pediatric patients with long bone fractures presenting to PEDs and GEDs and to use the extracted data to shape efforts for improved pediatric pain management across all emergency departments.

Design/Methods: A national database of 3.5 million pediatric emergency department patient visits between 2017-2021 was retrospectively analyzed for visits with a diagnosis of isolated long bone fracture injury. Differences in rates of medication administration, types of medication administered, and time to medication administration were analyzed. Adjusted odds ratios were calculated to analyze predictive factors for pain medication administration and timeliness.

Results: There were 12,414 visits in 8 PED facilities and 34,519 visits in 142 GED facilities available for analysis. 74.5% of patients in PEDs received any pain medication, as opposed to 69.6% of patients in GEDs (p < 0.001).  Opioids, ketamine, and local anesthetics were more commonly used in PEDs, whereas acetaminophen and non-steroidal anti-inflammatory medications (NSAIDs) were more commonly used in GEDs (p < 0.001). Opiate prescriptions at discharge were significantly more common in GEDs (6% vs. 13.9%, p< 0.001). Medications were administered with a median time of 37.5 minutes in PEDs and 49.0 minutes in GEDs (p < 0.001). In adjusted models, presentation to a PED was not significantly associated with receipt of pain medication (AOR 1.300 [0.914, 1.847]), but was predictive of receipt of pain medication within 30 minutes of arrival (AOR 2.298 [1.272, 4.152]).Conclusion(s): This data highlights broad differences in treatment of pain in isolated pediatric long bone fracture patients in PEDs and GEDs.  Use of ‘stronger’ medications such as opiates, ketamine and sedatives during the emergency department visit, more sedation procedures, and more admissions occurred in PEDs, likely due to increased injury severity. However, opiate prescriptions were more common on discharge from GEDs. Administration of more timely medications in PEDs suggests that there is education and outreach to be done in GED settings to improve pediatric pain management.
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