title: The relationship between patient age and pain management of acute long-bone fracture in the ED.
abstract: OBJECTIVE
  Certain patient populations may be unable to communicate their needs in the emergency department (ED) setting, and the ability to communicate varies between age groups. We aim to determine if there are differences in pain management of acute long-bone fracture (ALBF) among age groups presenting to the ED.
  
  
  METHODS
  This study was a retrospective chart review of a consecutive sample of subjects over 13 months. Fracture site, subject age, arrival time, whether pain medication was administered, and time to initial administration were recorded. Subjects were categorized into 3 groups based on age: pediatric (<18 years), adult (≥18 and <65 years), and geriatric (≥65 years).
  
  
  RESULTS
  A total of 1255 patients were included in analysis. One hundred seventy-seven (78.0%) pediatric, 364 (86.5%) adult, and 486 (80.1%) geriatric patients received pain medication during their ED stay. Median and average times to initial pain medication administration with 95% confidence intervals were 44 and 52.0 minutes (45.9-58.1), 39 and 53.6 minutes (48.8-58.4), and 55 and 73.2 minutes (68.1-78.3) for pediatric, adult, and geriatric groups, respectively. A single-factor analysis of variance indicated a significant difference between the groups (P<.01). Student t tests revealed significant differences between pediatric and geriatric groups (P<.01) and adult and geriatric groups (P<.01).
  
  
  CONCLUSIONS
  Although most patients presenting to the ED with ALBF were geriatric, these patients were the least likely to have their pain addressed in a timely fashion. Subgroup analysis of pediatric and geriatric populations indicates significant delay, especially for those ages younger than 3 and 85 years and older. We believe that patients within these groups experience the greatest difficulty communicating their needs effectively due to age-related issues.
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY. Electronic address: ericboccio@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Boccio
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wie
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Pasternak
authors.affiliation: Department of Emergency Medicine, Long Island Jewish Medical Center, Lake Success, NY.
authors.forename: Anabella
authors.initials: A
authors.lastname: Salvador-Kelly
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY.
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Ward
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY.
authors.forename: Jason
authors.initials: J
authors.lastname: D'Amore
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010147:Pain Measurement; D013997:Time Factors; D055815:Young Adult
chemical_list: D000700:Analgesics