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Current Practices of Administration of Analgesia in Pediatric Patients with Long Bone Fractures in the Emergency Department
Juliana Jaramillo, MD, Courtney Owens, MD, John Manning, MD, Michael Runyon, MD, Emily MacNeill, MD
Objective: This study evaluates the current practices of analgesia for long bone fractures in pediatric patients between various Emergency Departments (ED’s) identifying differences in receipt of and time to analgesia administration for different racial/ethnic groups
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Methods: This is a retrospective, observational study of children evaluated throughout a healthcare system among hospital types (urban, free-standing, rural/suburban, pediatric tertiary care (PED)) from June 1, 2018, through June 30, 2019. Inclusion criteria included patients age < 18 years with an ICD-10 code for long-bone or clavicular fracture. Information obtained from EMR included age, insurance, race/ethnicity, pain scores, diagnosis, and analgesia administration.
Results: 2,300 patients met inclusion criteria; data from 1,576 patients was analyzed across the four hospital types. 1,014 patients across sites indicated a pain score in the range of 6-10; of this sub-group, 82.4% (95%CI: 79.8-84.6) of patients received analgesia and 45.8% (95%CI: 42.6-48.8) received an opioid or pain dose ketamine. For any analgesia administration, there was no significant difference between races / ethnicities across the study sites though there was a statistically significant difference in opioid/ketamine administration. Only urban and PED sites showed a statistically significant racial/ethnic disparity regarding who received opioid/ketamine analgesia. Median time to administration across all sites was 48 minutes (IQR: 26-80) regardless of analgesic type. Across all sites there was a significant difference in timing of analgesia depending on race/ethnicity.
Conclusion: We found undertreatment of pediatric patients with significant pain from long bone fractures and disparity in analgesic administration, most apparent in sites that see more diverse populations.
