423 - Factors Associated with Timely and Effective Pain Management for Pediatric Long Bone Fractures

Poster Number: 423
Publication Number: 423.2891

Background: Long-bone fractures (LBFs) are highly prevalent and among the most painful conditions encountered by pediatric patients in the emergency department (ED). Wide variation has been demonstrated in timely analgesia in addition to disparities in the administration of analgesia.

Objective: We aimed to identify factors associated with the timeliness of initial analgesia and the reduction of initial pain in children with LBFs with moderate to severe pain presenting to two large academic pediatric EDs

Design/Methods: We conducted a cross-sectional analysis of pediatric patients (ages 0-18) at two pediatric EDs between 03/2020 and 05/2023, with an ICD10 encounter diagnosis code for LBF and initial pain scores ≥4. The primary outcome was any analgesia within 60 minutes of arrival. Secondary outcomes included pain reassessment and reduction of initial pain. Our analysis used t-tests for continuous variables and Chi-Square tests for categorical variables.

Results: Out of 3,550 patients with LBFs, 1,964 (55%) initially experienced moderate to severe pain. The majority of patients received pharmacologic analgesia (1754 (89%)), more commonly with non-opioids (57%, N=1,112) than opioids (33%, N=642). There were no significant associations between race, primary language, or sex and receipt of analgesia within 60 minutes, except for an increased odds for Chinese-speaking patients (OR 1.29, 95% CI: 1.01-1.64) [Table 1]. Patients with upper extremity fractures (OR 0.77, 95% CI: 0.61-0.97) or those aged 13-18 (OR 0.71, 95% CI: 0.53-0.95) had decreased odds of receiving analgesia within 60 minutes.

The majority of patients (88%, N=1,724) received reassessment, with a median time of 106 minutes (IQR: 54, 174) between initial and subsequent pain assessments. There were no significant associations between race, primary language, sex, fracture type, and any reduction of pain from the initial pain assessment [Table 2]. However, older patients had decreased odds of initial pain reduction (Age 6-12: OR 0.54, 95% CI: 0.41-0.69; Age 13-18: OR 0.37, 95% CI: 0.28-0.50) and optimal pain reduction (Age 6-12: OR 0.45, 95% CI: 0.35-0.57; Age 13-18: OR 0.22, 95% CI: 0.16-0.29).

Conclusion(s): Older patients with LBFs in moderate to severe pain had decreased odds of timely analgesia and optimal pain reduction in our study, which we plan to study further. There were little to no differences among race, ethnicity, language, and sex with respect to the timeliness of pain management or reduction in pain.