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

摘要 疼痛治疗是所有医疗保健提供者以患者为中心的基本目标。骨折疼痛治疗 儿童的情况是不一致的，而且往往是不适当的。没有明确的证据表明， 使用的药物在临床上最有效。对于长骨疼痛的最佳治疗方法没有达成共识 骨折时，使用的药物仍然存在差异，或者完全不一致地使用止痛剂。 治疗不足的疼痛与功能下降和健康相关的生活质量下降有关。然而，在这方面， 阿片类药物滥用的流行导致过量、事故和死亡率不断上升。这种二分法 对提供者做出知情、负责任的儿童处方决定构成了严重挑战， 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局，以促进达到 为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、多中心、纵向比较有效性研究， 疼痛治疗的已知变异性，以确定最有效的推荐镇痛方案， 在艾德和家中患有骨折疼痛的儿童。我们将使用已建立的多中心存储库， 在六个卫生系统收集的所有急诊科（艾德）就诊的电子健康记录数据， 这是对50多万名儿童的年度普查。这些数据将被链接到一个移动的健康 前瞻性收集有关疼痛、功能结局和不良反应的信息， 出院后家庭使用电子技术。结合起来，该提案将比较患者特定的疼痛 从医院到家庭的连续护理的经验数据，以确定最佳做法。 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 本研究旨在评价所有急性疼痛儿童的艾德和艾德后疼痛治疗并提供证据。 与疼痛有关。独特的是，本研究前瞻性地跟踪了从艾德访视到家庭的完整患者体验。 现有疼痛管理策略与相关短期患者结局的直接比较 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.