Differences in Pain management for children with fractures. General and Pediatric Emergency Departments

Background and Objectives:
Children presenting to the emergency department (ED) with injuries often experience pain and distress. Pain management in the ED has been previously shown to be inconsistent and inadequate. Moreover, children with fractures are treated with less analgesia and opioids than adults with similar fractures.

Patients & Methods :
This is a retrospective observational study in a regional hospital serving northeastern Israeli population. We compared the variations in administration of analgesia between the general trauma ED and the Pediatric ED (PED) in children presenting with long bone fractures . WE compared all patients younger than 18 y Who presented to the ED with long bone fractures between 2015-2020.
Primary outcome measure was the administration of analgesia (any analgesia and opioid analgesia). Secondary outcome measures were time to analgesia, time to physician assessment and length of stay in the ED.

Results :
1067 patients were evaluated ( 716 boys 350 girls). 370 presented to the PED and 697 presented to the general trauma ED. 43.5% received any analgesia and 22.4% received opioids in the PED compared to 5% and 2.9% respectively in the general trauma ED (P<0.0001).

Conclusions :
Pediatric patients with fractures are treated with more analgesia and more opioid analgesia in the Pediatric ED compared to the general trauma ED. Time to analgesia and to physician assessment were shorter in the Pediatric ED compared to the general trauma ED. Overall analgesia rates are low!