title: The effect of standard care, ibuprofen, and distraction on pain relief and patient satisfaction in children with musculoskeletal trauma.
abstract: BACKGROUND
  The purpose of this study was to determine the effectiveness of nursing interventions in decreasing pain for children with minor musculoskeletal trauma and moderate pain and to examine patient satisfaction.
  
  
  METHODS
  Children were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization) only; (2) standard care and ibuprofen; or (3) standard care and distraction. Children were monitored for pain ratings for 60 minutes. Children who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 2 or greater using the 0-5 Wong/Baker faces scale were included. Two patient satisfaction questions were asked of parents upon their child's discharge from the emergency department.
  
  
  RESULTS
  A statistically significant decrease in pain for all patients (76) occurred at 30 minutes (F = 4.39, P <.05) and was maintained at 60 minutes. The distraction group demonstrated a statistically significant reduction in pain compared with the other groups at 30 minutes; this reduction was maintained at 60 minutes (F = 47.07, P <.05). Parents of only 6 children expressed dissatisfaction with overall pain management. Twelve percent of children who were not in the group receiving medication received analgesics while in the emergency department. At discharge, only 37% of children with fractures and/or sprains had received medications for pain.
  
  
  CONCLUSIONS
  Children with musculoskeletal trauma may be under-medicated. Distraction techniques can be an effective adjunct to analgesia for children with musculoskeletal pain in the emergency department and should be made available. Ibuprofen may not be an effective analgesic for children with these injuries; stronger analgesics may be required.
authors.affiliation: Emergency Department, Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, IL, USA. m.tanabe@attbi.com
authors.forename: Paula
authors.initials: P
authors.lastname: Tanabe
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ferket
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Judith
authors.initials: J
authors.lastname: Paice
authors.forename: Richard
authors.initials: R
authors.lastname: Marcantonio
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001288:Attention; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D009141:Musculoskeletal System / Q000293:injuries*; D009146:Music; D059408:Pain Management; D010147:Pain Measurement; D017060:Patient Satisfaction; D010988:Play and Playthings; D013180:Sprains and Strains / Q000628:therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen