Poorly Controlled Pediatric Fracture Pain Requiring Unplanned Medical Assistance or Advice. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Kopp, Tara M.; Frey, Theresa M.; Zakrajsek, Mark; Nystrom, Jennifer; Koutsounadis, Gena N.; Falcone, Kelly S.; Zhang, Yin; Wall, Eric; Byczkowski, Terri; Mittiga, Matthew R.
• Is Part Of: Pediatric emergency care. Volume 38:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: fracture -- pain -- injury -- opioids; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002304
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: This study aimed to define the proportion of children who seek assistance for poorly controlled fracture pain, identify factors associated with requesting help, and explore caregivers' opioid preferences. Methods: We enrolled 251 children and their caregivers in the orthopedic surgery clinic of a tertiary care children's hospital. Children 5 to 17 years old presenting within 10 days of injury for follow-up for a single-extremity, nonoperative long bone fracture(s) were eligible. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain before the first routine follow-up appointment by telephone call, medical visit, or rescheduling to an earlier appointment. Factors associated with the outcome were assessed using bivariable analysis. Results: Overall, 7.3% (95% confidence interval, 4.1%–10.6%) of participants sought unscheduled evaluation or advice for poorly controlled pain. The 2 most common reasons were to obtain over-the-counter analgesic dosage information (64.7%) and a stronger analgesic (29.4%). These children were more likely to have a leg fracture, have an overriding or translated fracture, or require manual reduction under procedural sedation. These children had higher Patient-Reported Outcomes Measurement Information System Pain Behavior and Pain Interference scores and more anxious caregivers. One-third of caregivers expressed hesitancy or refusal to use opioids to treat severe pain, and 45.7% reported potential addiction or abuse as the rationale. Conclusions: A notable proportion of children seek assistance for poorly controlled fracture-related pain. Medical providers should target discharge instructions to the identified risk factors and engage caregivers in shared decision making if opioids are recommended. Abstract : Supplemental digital content is available in the text.