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Outpatient Pediatric Pain Management Practices for Fractures

L. Drendel, Amy DO, MS*; Lyon, Roger MD; Bergholte, Jo MS*; Kim, Michael K. MD*

doi: 10.1097/01.pec.0000199564.64264.f4
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Objectives: Describe the pattern of utilization and effectiveness of outpatient fracture pain medication.

Methods: A cross-sectional survey of caregivers of children with an isolated extremity fracture at a hospital-based pediatric orthopedic clinic during initial follow-up.

Results: Surveys were completed by 98 (79.2%) of 125 caregivers. Mean age of children was 9 years (range, 1-18 years). Fracture sites include arm (36%), wrist (24%), hand (6%), leg (14%), ankle (9%), and foot (6%). Pain was reported "worst" at the time of injury in 45.3% patients (95% confidence interval [CI], 35.0%-55.8%) and in the first 48 hours of injury in 30.5% patients (95% CI, 21.5%-40.8%). The most commonly used medications were ibuprofen 43.5% (95% CI, 34.4%-52.5%) and acetaminophen with codeine 26.1% (95% CI, 18.1%-34.1%). Mean duration of medication use was 3.2 days (95% CI, 2.8-3.6 days). The mean duration of functional limitations included 4.2 days (95% CI, 2.8-5.5 days) for playing, 2.6 days (95% CI, 1.7-3.4 days) for performing at school, 2.4 days (95% CI, 1.8-3.0 days) for sleeping, and 2.0 days (95% CI, 1.0-3.0 days) for eating. Mean days of work missed by caregivers was 1.6 (95% CI, 1.1-2.0 days), and days of school missed by children was 2.0 (95% CI, 1.6-2.3 days). Significantly more children with lower extremity fractures had functional limitation (P < 0.05).

Conclusion: Most children with fractures have the "worst" pain in the first 48 hours after injury and used analgesia for 3 days after injury. There are noteworthy functional limitations for both children and their caregivers. Ibuprofen and acetaminophen with codeine are the analgesics most commonly used, with no clear superiority.

*Emergency Medicine Section and †Orthopedic Division, Pediatric Department, Children's Hospital of Wisconsin, Milwaukee, WI.

Address correspondence and reprint requests to Amy L. Drendel, DO, MS Children's Hospital of Wisconsin, Emergency Medicine Section, Pediatric Department, 9000 W. Wisconsin Avenue MS 677, Milwaukee, WI 53226. E-mail: adrendel@mail.mcw.edu.

© 2006 Lippincott Williams & Wilkins, Inc.