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Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Published online by Cambridge University Press:  04 March 2015

Janeva Kircher ,
Amy L. Drendel ,
Amanda S. Newton ,
Sukhdeep Dulai ,
Ben Vandermeer  and
Samina Ali
Janeva Kircher*
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
Amy L. Drendel
Affiliation:
Department of Pediatrics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
Amanda S. Newton
Affiliation:
Women and Children’s Health Research Institute, Edmonton, AB Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
Sukhdeep Dulai
Affiliation:
Department of Surgery, University of Alberta, Edmonton, AB
Ben Vandermeer
Affiliation:
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
Samina Ali
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Women and Children’s Health Research Institute, Edmonton, AB Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
*
Correspondence to: Dr. Samina Ali, Department of Pediatrics, Edmonton Clinic Health Academy, 11405 – 87 Avenue, Edmonton, AB T6G 1C9, sali@ualberta.ca.

Abstract

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Objective:

Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.

Methods:

We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.

Results:

A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.

Conclusions:

Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.

Keywords

emergencyfracturemusculoskeletalpainpediatric
Type
Original Research • Recherche Originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 6 , November 2014 , pp. 449 - 457
Copyright
Copyright © Copyright © Canadian Association of Emergency Physicians 2014

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