Pediatrics/Original ResearchEmergency department analgesia for fracture pain*,**,*
Introduction
Several studies have evaluated administration of analgesia in the emergency department (ED) and have reported that patients frequently do not receive medication for painful conditions.1, 2, 3, 4 Recently, the Joint Commission on Accreditation of Healthcare Organizations stated that “unrelieved pain has adverse physical and psychological effects. The patient's right to pain management is respected and supported.” The practice standard to which health care organizations are now held states that “pain is assessed in all patients.”5 Given the current literature on analgesia in ED settings and the emphasis of the Joint Commission on Accreditation of Healthcare Organizations on provision of adequate analgesia to patients in pain, we sought to determine whether appropriate analgesia was being provided to pediatric and adult ED patients with potentially painful fractures during 1997 to 2000.
Using a national survey of ED visits, we evaluated patients with extremity and clavicular fractures treated in EDs. We described variations in analgesic use by age and compared the use of analgesia for adults with that for children. We repeated these analyses for the subset of patients with moderate or severe pain on pain severity scores. In children, we also compared treatment between pediatric and nonpediatric facilities.
Section snippets
Methods
We used data from the ED component of the National Hospital Ambulatory Medical Care Survey, which was directed by the Centers for Disease Control and Prevention's National Center for Health Statistics, for 1997 to 2000. Community and academic hospitals, including children's hospitals, were included in this survey, whereas federal hospitals and freestanding clinics were excluded. EDs were eligible only if they were open and staffed 24 hours a day. The survey used a 4-stage sampling design to
Results
During the 4 study years, there were 2,828 ED visits for isolated closed fractures of the extremities or clavicle that met inclusion and exclusion criteria in the sample (Figure 1), which represents a national estimate of 12.5 million ED visits a year. The characteristics of these patients are shown in Table 1.Characteristic All Ages, No.(%) Age Category, No. (%) 0-3 y 4-8 y 9-15 y 16-29 y 30-69 y ≥70 Total visits, No. (%)*
Discussion
A third of the fracture patients in our study did not receive any pain medications. The proportion of patients receiving pain medications was even lower in children.
Pain severity scores appear to be underused in the ED setting. Pain scores were recorded in only 59% of patients overall, and in only 47% of children younger than 4 years. Even when pain scores were recorded as moderate or severe, analgesics were not routinely used. For patients with documented moderate to severe pain, 73% overall
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Cited by (0)
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The authors report this study did not receive any outside funding or support.
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Address for reprints: Julie C. Brown, MD, MPH, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Mailstop 5D-1, Seattle, WA 98105; 206-987-2599, fax 206-729-2070; E-mail,[email protected].
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Author contributions: JCB and EJK conceived and designed the study, drafted and revised the manuscript, and performed the analysis and interpretation. JCB, CWL, and BDJ managed the dataset. CWL, BDJ, and PC reviewed the manuscript and assisted with the analysis. PC provided statistical consultation regarding accuracy of the analysis and presentation of the results. JCB takes responsibility for the paper as a whole.