Abstract
Under treatment of pain is frequently reported in children even in conditions associated with severe pain such as fractures. Recent literature supports adequate and early pain treatment because extreme and uncontrolled pain can lead to hyperalgesia. Since 2017, the treatment of pediatric orthopedic cases in the “Meir” Medical Center was gradually shifted from the orthopedic general emergency department to the pediatric emergency department. The objective was to examine the differences in pain management between the orthopedic and pediatric emergency departments. Upper limb fractures were chosen as a representing case. This retrospective cohort study included children aged 0–18 years that suffered from an upper limb fracture and were admitted to the emergency department in the years 2016 and 2018. In our study, a total of 2520 children suffered from an upper limb fracture and were treated at the Meir Medical Center during the study period. 959 of these children were treated during 2016 in the general emergency department, and 1561 were treated in the pediatric emergency department during 2018. The group characteristics were similar. In the pediatric emergency department compared to general emergency department group, more children received analgesic treatment (47.85% versus 30.4%, p < .001), more opiates were given (13.9% versus 5.3%, p < .001), and the analgesic treatment was more adequate to pain severity. Additionally, sedation was performed more frequently in the pediatric emergency department (21.6% versus 9.5%, p < .001), especially for dislocated fractures (81.5% versus 31.4%, p < .001). Complications: Length of stay, surgery, hospitalization, and recurrent referral rates were similar between the two groups.
Conclusions: The transfer of orthopedic pediatric cases to the pediatric emergency department showed a notable improvement in pain management without an increase in complications or emergency department length of stay.
What is Known: • Pain management and control is a major issue to address in their treatment. • Traumatic injuries and especially fractures are common causes for ED admissions. | |
What is New: • Comparing pain management and upper limb fractures treatment between general and pediatric ED. • Pain is better treated in the PED than in the GED, without an increased rate of complications. |
Similar content being viewed by others
Abbreviations
- ED:
-
Emergency department
- GED:
-
General emergency medicine
- GED:
-
General emergency department
- HB:
-
Hematoma block
- LOS:
-
Length of stay
- PED:
-
Pediatric emergency department
- PSS:
-
Pain severity score
References
Krauss BS et al (2016) Current concepts in management of pain in children in the emergency department. Lancet 387:83–92
Capua et al (2018) The influence of an accredited pediatric emergency medicine program on the management of pediatric pain and anxiety. Isr J Health Policy Res. https://doi.org/10.1186/s13584-018-0211-6
Noble J et al (2020) Analgesia use in children with acute long bone fractures in the pediatric emergency department. J Emerg Med 58(3):500–505. https://doi.org/10.1016/j.jemermed.2019.09.018 (Epub 2019 Nov 16)
AAP Committee on Psychosocial Aspects of Child and Family Health (2001) Task Force on Pain in Infants, Children, and adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 108:793–797
Godwin SA et al (2014) Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 63:247–258. e18
American Society for Pain Management Nursing (ASPMN) (2010) Emergency nurses association (ENA); American College of Emergency Physicians (ACEP); American pain society (APS). Optimizing the treatment of pain in patients with acute presentations. Policy statement. Ann Emerg Med 56:77–79
World Health Organization (2012) WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Available at http://whqlibdoc.who.int/publications/2012/9789241548120_Guidelines_pdf. Accessed 25 June 2017
Cimpello et al (2004) Practice patterns of pediatric versus general emergency physicians for pain management of fractures in pediatric patients. Pediat Emerg Care Volume 20 Number 4
Weng Y-M et al (2010) Triage pain scales cannot predict analgesia provision to pediatric patients with long-bone fracture. Am J Emerg Med 28(4):412–417. https://doi.org/10.1016/j.ajem.2008.12.035
Emergency Department Admissions (2018) Israel ministry of health - information department. March 2020. https://www.health.gov.il/PublicationsFiles/emergency_2018.pdf
Heilman JA, Tanski M, Burns B et al (2016) Decreasing time to pain relief for emergency department patients with extremity fractures. BMJ Qual Improv Rep 5:u209522.w7251. https://doi.org/10.1136/bmjquality.u209522.w7251
Schuman SS, Regen RB, Stuart LH, Harrell C, Jones TL, Stewart BM, Berg AM, Longjohn M, Kink RJ (2018) Reducing time to pain medication administration for pediatric patients with long bone fractures in the emergency department. Pediatr Qual Saf 3:e120
Pediatric pain and anxiety management in children treated in the pediatric emergency department – clinical guidelines. Israel pediatric association, 2010. https://www.ima.org.il/MainSiteNew/EditClinicalInstruction.aspx?ClinicalInstructionId=52
Coté CJ, Wilson S (2019) American Academy of Pediatrics, American Academy of Pediatric Dentistry Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 143(6):e20191000
Fein JA et al (2012) Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics Volume 130 Number 5. https://doi.org/10.1542/peds.2012-2536
Bear et al (2015) Hematoma block versus sedation for the reduction of distal radius fractures in children. J Hand Surg Am 40(1):57e61
Fathi M et al (2015) Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial. Emerg Med J 32:474–477. https://doi.org/10.1136/emermed-2013-202485
Author information
Authors and Affiliations
Contributions
DK conception and design of the work. SLE, DK, DS conducted data collection and performed data analysis. SLE, DK, AS, HY, and ER contributed to data interpretation. AS, HY, and ER assisted in drafting the manuscript. All authors critically revised the manuscript and read and approved the final manuscript for submission.
Corresponding author
Ethics declarations
Ethics approval
Approved by the local ethics committee.
Consent to participate
N/A.
Consent for publication
N/A.
Conflict of interest
The authors declare no competing interests.
Additional information
Communicated by Daniele De Luca.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Takagi, D., Less Elazari, S., Shles, A. et al. Pain management of upper limb fractures in pediatric emergency department versus general orthopedics emergency department. Eur J Pediatr 181, 1541–1546 (2022). https://doi.org/10.1007/s00431-021-04310-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-021-04310-w