학술논문
Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study.
Document Type
Academic Journal
Author
Cozzi G; Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.; Cortellazzo Wiel L; Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy luisacortellazzowiel@gmail.com.; Bassi A; Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.; Giangreco M; Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.; Dibello D; UOC Orthopedics and Traumatology, Giovanni XXIII Pediatric Hospital, Bari, Italy.; Rozzo M; Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.; Di Carlo V; Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.; Genovese MRL; Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.; Barbi E; Department of Paediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.; Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Source
Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 100963089 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1472-0213 (Electronic) Linking ISSN: 14720205 NLM ISO Abbreviation: Emerg Med J Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables.
Methods: A prospective observational cross-sectional study was conducted at the ED of the children's hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0-17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ2 or Fisher's exact tests were used to assess secondary outcomes.
Results: During the study period, 213 patients, mean age 10 years (IQR: 8-13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child's age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).
Conclusion: Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Methods: A prospective observational cross-sectional study was conducted at the ED of the children's hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0-17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ
Results: During the study period, 213 patients, mean age 10 years (IQR: 8-13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child's age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).
Conclusion: Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)