title: Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge.
abstract: OBJECTIVE
  The aims of this study are to determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.
  
  
  METHODS
  This is a prospective observational study of children aged 4 to younger than 18 years and presenting to the ED with extremity fracture from May 2010 to February 2011. The Parents' Postoperative Pain Measure, which scores pain according to 15 behavior-related questions, was completed 48 to 72 hours after discharge. A score greater than or equal to 6 of 15 indicates clinically meaningful pain. Univariate tests and multivariable regression analyses were used to compare Parents' Postoperative Pain Measure scores between cohorts.
  
  
  RESULTS
  Two hundred fifty-seven patients were enrolled; 202 (79%) had Parents' Postoperative Pain Measure scores for analysis. Pain scores greater than or equal to 6 were reported by 37 of 102 (36%) of the simple casted and 44 of 100 (44%) of the reduced casted children. There was no difference in scores between the simple (median 4.0) and reduced casted (median 5.0) cohorts (difference 16.7%; 95% confidence interval [CI] -3.0% to 40%). In the multivariate analysis, ED narcotic administration was associated with 24% higher Parents' Postoperative Pain Measure scores (95% CI 0.95% to 53.6%). Children receiving ED narcotics had more than 2 times increased odds of pain scores greater than or equal to 6 after discharge (95% CI 1.24 to 5.39).
  
  
  CONCLUSIONS
  Children in both simple casted and reduced casted groups had clinically meaningful pain after ED discharge. Identifying these children is important to improving pain management and discharge care.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, MA, USA.
authors.forename: Rachel W
authors.initials: RW
authors.lastname: Thompson
authors.forename: Baruch
authors.initials: B
authors.lastname: Krauss
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Salim
authors.initials: S
authors.lastname: Zerriny
authors.forename: Lois K
authors.initials: LK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002370:Casts, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D059408:Pain Management / Q000706:statistics & numerical data; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology; D010351:Patient Discharge; D011446:Prospective Studies