Early Opiate Analgesic Requirements Following Nonsurgically Managed Tibial Fractures in Children

Yap, Rye Y; Sultan, Sanaah; Ahmad, Husham; Marson, Ben; Ikram, Adeel; Ollivere, B.; Ławniczak, Dominik

doi:10.1097/bpo.0000000000001914

Cited by 2 publications

(1 citation statement)

References 26 publications

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“…There has been an increasing awareness of non-surgical management of limb fractures and emergency department manipulation which avoid inpatient admission. [18][19][20][21][22] Importantly, such fractures and their management would not be captured in this data.…”

Section: Discussionmentioning

confidence: 99%

Trends in hospital admissions for childhood fractures in England

Marson

Manning

James

et al. 2021

bmjpo

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PurposeFractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals.DesignThe study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children.ResultsDuring 2012–2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5–9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10–15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0–4) children has been increasing at a rate of 0.629 per 100 000 children per year.ImplicationsThe annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.

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Section: Discussionmentioning

confidence: 99%

Trends in hospital admissions for childhood fractures in England

Marson

Manning

James

et al. 2021

bmjpo

Self Cite

View full text Add to dashboard Cite

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Fracture pain in children in the emergency department: the impact of a new pain management procedure

Liber,

De Jorna,

Abidji

et al. 2024

BMC Emerg Med

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Purpose To compare compliance with the French national guidelines before and after the implementation (in 2018) of a new protocol on acute fracture pain management in the pediatric emergency department of a French university medical center. Methods We conducted a retrospective, before-after study in patients aged below 16 years presenting at the pediatric emergency department with a fracture. We compared pain management before (in 2017) and after (in 2019 and 2020) implementation of the new procedure. The primary endpoint was appropriate pain management, defined as (i) an appropriate initial assessment of pain, (ii) appropriate treatment with analgesic drugs (acetaminophen for mild pain, acetaminophen and ibuprofen for moderate pain, ibuprofen and morphine for severe pain) and (iii) reassessment of the pain intensity. Results 572 patients were included (mean age: 6.5 years; male: 60%). 190 in 2017 and 382 in 2019–2020. Pain management was appropriate for 40% of the patients in 2017 and 52% in 2019–2020 (p = 0.004). Pain was rated for 98% of patients in 2017 vs. 100% in 2019–2020 (p = 0.04). The frequency of appropriate treatment for mild pain and moderate pain increased significantly from 52 to 76% and from 0 to 44%, respectively. The administration of ibuprofen increased by 26% points (from 3 to 20 patients treated) and the administration of morphine increased by 29% points (from 1 to 17 patients treated). Pain reassessment rose significantly from 21 to 43%. Levels of compliance with the guidelines were similar in 2019 and 2020. Analgesia was significantly more effective in 2019–2020 than in 2017 (in 20% vs. 14% of the patients, respectively; p = 0.005). Conclusion After the implementation of a new protocol for the management of acute fracture pain, we observed an increase in compliance with the guidelines. Although the use of ibuprofen and morphine rose significantly as did the frequency of pain reassessment, further improvements are required.

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Early Opiate Analgesic Requirements Following Nonsurgically Managed Tibial Fractures in Children

Cited by 2 publications

References 26 publications

Trends in hospital admissions for childhood fractures in England

Trends in hospital admissions for childhood fractures in England

Fracture pain in children in the emergency department: the impact of a new pain management procedure

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