title: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.
abstract: Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0-18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.
authors.affiliation: Faculty of Nursing, University of Montreal, Montreal, QC, Canada H3T 1A8; CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5.
authors.forename: Sylvie
authors.identifier: 0000-0003-4106-6068
authors.initials: S
authors.lastname: Le May
authors.affiliation: Women and Children's Health Research Institute, Edmonton, AB, Canada T6G 1C9; Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada T6G 1C9.
authors.forename: Samina
authors.identifier: 0000-0002-0595-364X
authors.initials: S
authors.lastname: Ali
authors.affiliation: Faculty of Nursing, University of Montreal, Montreal, QC, Canada H3T 1A8; CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5; McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: Christelle
authors.identifier: 0000-0002-5198-1561
authors.initials: C
authors.lastname: Khadra
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Amy L
authors.identifier: 0000-0001-9810-6847
authors.initials: AL
authors.lastname: Drendel
authors.affiliation: CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5; Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, QC, Canada H3T 1C5.
authors.forename: Evelyne D
authors.initials: ED
authors.lastname: Trottier
authors.affiliation: CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5; Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, QC, Canada H3T 1C5.
authors.forename: Serge
authors.initials: S
authors.lastname: Gouin
authors.affiliation: Children's Hospital, London Health Sciences Centre, London, ON, Canada N6A 5W9; Schulich School of Medicine and Dentistry, London, ON, Canada N6A 5C1; Child Health Research Institute, London, ON, Canada N6C 2V5.
authors.forename: Naveen
authors.identifier: 0000-0003-1540-0413
authors.initials: N
authors.lastname: Poonai
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D006801:Humans; D009135:Muscular Diseases / Q000150:complications*; D063806:Myalgia / Q000209:etiology* / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010372:Pediatrics; D016032:Randomized Controlled Trials as Topic