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

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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.