title: Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation.
abstract: 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  =  468 pediatric ED, n  =  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 ± 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.
authors.forename: Janeva
authors.initials: J
authors.lastname: Kircher
authors.forename: Amy L
authors.initials: AL
authors.lastname: Drendel
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Sukhdeep
authors.initials: S
authors.lastname: Dulai
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
mesh_terms: D000416:Alberta; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D059352:Musculoskeletal Pain / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics