Emergency department analgesia for fracture pain.
OBJECTIVE
We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.


METHODS
Analysis of the ED component of the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1997 through 2000 was conducted. The proportion of patients with closed extremity and clavicular fracture that received any analgesic and narcotic analgesic medications was determined for each age category. Survey-adjusted regression analyses compared pain and narcotic medications by age and ED type (pediatric versus other). Analyses were repeated for the subset of patients with moderate or severe pain severity scores.


RESULTS
Of 2,828 patients with isolated closed fractures of the extremities or clavicle, 64% received any analgesic and 42% received a narcotic analgesic. Pain severity scores were recorded for 59% of visits overall, 47% of children younger than 4 years, and 34% of children younger than 1 year. Among patients with documented moderate or severe pain, 73% received an analgesic and 54% received a narcotic analgesic. Compared with adults, a lower proportion of children (< or = 15 years) received either any analgesic or a narcotic analgesic (P <.001). After adjustment for confounders and survey design, the proportion of patients aged 0 to 3, 4 to 8, 9 to 15, 16 to 29, 30 to 69, and 70 years and older who received any analgesic was 54% (95% confidence interval [CI] 41% to 67%), 63% (95% CI 57% to 68%), 60% (95% CI 57% to 64%), 67% (95% CI 62% to 73%), 68% (95% CI 64% to 72%), and 58% (95% CI 52% to 65%), respectively; the proportion who received a narcotic analgesic was 21% (95% CI 11% to 31%), 30% (95% CI 22% to 37%), 27% (95% CI 23% to 32%), 47% (95% CI 40% to 54%), 51% (95% CI 46% to 56%), and 41% (95% CI 35% to 48%), respectively. Compared with children treated in other EDs, children treated in pediatric EDs were about as likely to receive any analgesia (adjusted relative risk [RR] 1.1; 95% CI 0.9 to 1.3) or narcotic analgesia (adjusted RR 0.9; 95% CI 0.6 to 1.2).


CONCLUSIONS
In pediatric and adult patients, pain medications were frequently not part of ED treatment for fractures, even for visits with documented moderate or severe pain. Pain severity scores were often not recorded. Pediatric patients were least likely to receive analgesics, especially narcotics.
Brown
Julie C
JC
Department of Pediatrics, University of Washington, School of Medicine and the Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA. julbrown@u.washington.edu
Klein
Eileen J
EJ
Lewis
Charlotte W
CW
Johnston
Brian D
BD
Cummings
Peter
P
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000698:Analgesia / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000293:injuries*; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005121:Extremities / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D019538:Health Care Surveys; D006764:Hospitals, Community; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States