The Effect of Emergency Department and After-Emergency Department Analgesic Treatment on Pediatric Long Bone Fracture Outcomes

摘要 疼痛的治疗是所有医疗保健提供者以患者为中心的基本目标。骨折痛的治疗 儿童是不一致的，而且往往是不充分的。没有明确的证据表明哪种常见的 使用的药物在临床上最有效。对于长骨的最佳疼痛治疗方法还没有达成共识 对于骨折，使用的药物仍然不同，或者止痛剂的使用完全不一致。 治疗不足的疼痛与功能下降和与健康相关的生活质量下降有关。然而， 阿片类药物滥用流行导致服药过量、事故和死亡率上升。这种二分法 对为儿童做出知情、负责任的处方决定的提供者构成了严重的挑战 导致了所用药物的显著差异。实践中的这种可变性将使我们能够 检查与各种治疗方案相关的临床相关结果，以促进 就儿童骨折疼痛的最佳治疗达成共识。 我们将进行一项前瞻性的多中心纵向比较有效性研究，该研究将利用 在疼痛治疗中确定最有效的推荐止痛方案的已知变异性 急诊室和家里有骨折痛的儿童。我们将使用已建立的多中心存储库 为六个卫生系统的所有急诊科就诊收集的电子健康记录数据， 相当于每年超过500,000名儿童的人口普查。这些数据将链接到移动健康 一种前瞻性地收集有关疼痛、功能结果和不良反应的信息的解决方案 出院后的家庭使用电子技术。结合起来，这项建议将比较不同患者的疼痛 体验从医院到家庭的整个护理过程中的数据，以确定最佳实践。 我们的长期目标是改善受伤儿童的儿科疼痛治疗。这个项目的总体目标是 这项研究旨在评估和提供急救和急救后疼痛治疗的证据。 骨折相关的疼痛。独一无二的是，这项研究前瞻性地跟踪了从急诊到家访的完整患者体验。 现有疼痛管理策略与相关短期患者预后的直接比较 将定义最有效的急性疼痛管理实践。

ABSTRACT Treatment of pain is an essential patient-centered goal for all healthcare providers. Fracture pain treatment for children is inconsistent and often inadequate. There is no clear evidence demonstrating which of the commonly used medications are most clinically effective. With no consensus on the best pain treatment for long bone fractures, there remains variability in medication utilized or inconsistent use of analgesic altogether. Undertreated pain is associated with reduced function and decreased health related quality of life. However, the opioid abuse epidemic has resulted in increasing rates of overdose, accidents and death. This dichotomy poses a serious challenge for providers making informed, responsible prescription decisions for children and has resulted in significant variability in the medications utilized. This variability in practice will allow us to examine clinically relevant outcomes associated with the various treatment regimens to facilitate reaching consensus for the best treatment for children with fracture pain. We will perform a prospective multi-center, longitudinal comparative effectiveness study that capitalizes on the known variability in pain treatment to determine the most effective recommended analgesic regimen for children with fracture pain in the ED and at home. We will use an established multi-center repository of electronic health record data collected for all Emergency Department (ED) visits at six health systems, representing a combined annual census of over 500,000 children. These data will be linked to a mobile health solution that prospectively collects information about pain, functional outcomes and adverse effects from families after discharge using e-technology. In combination, this proposal will compare patient-specific pain experience data over the continuum of care from the hospital to the home to determine best practice. Our long-term goal is to improve the treatment of pediatric pain for injured children. The overall goal of this study is to evaluate and provide evidence for both ED and post-ED pain treatment for all children with acute fracture-related pain. Uniquely, this study prospectively tracks the full patient experience from ED visit to home. The direct comparison of existing pain management strategies and the associated short-term patient outcomes will define the most effective acute pain management practice.