EMERGENCY DEPARTMENT ANALGESIC USE IN PEDIATRIC TRAUMA VICTIMS WITH FRACTURES

Study objective: To investigate the frequency of emergency department analgesic use in children with presumably painful fractures who are al so at risk for associated multiple injuries and to determine whether t here are specific factors that distinguish those who are prescribed an algesics from those who are not. Design: Descriptive; retrospective re view of a computerized,: trauma registry. Setting: Regional pediatric ED and trauma center. Participants: Four hundred thirty-three injured children met trauma team activation criteria from January 1, 1991 thro ugh June 30, 1992. Of these 433, we selected the 121 children who had fractures of the pelvis, long bones, ankle, wrist, or clavicle. Of the se 121,we excluded the 22 children who underwent endotracheal intubati on. Trauma registry data from the prehospital and ED phases of care fr om the remaining 99 children were reviewed far this study. Interventio ns: None. Main results: Of the study group, 53% (52 of 99) received an algesics, all narcotics. Excluding the 46 children with multisystem in juries, only 62% (33 of 53) received analgesics. Patients in both the analgesic (52) and no-analgesic groups (47) were mildly to moderately injured based on initial ED trauma scores and vital signs. No statisti cal or clinical significant differences were found between the analges ic group and the no-analgesic group when comparing age, sex, race, mec hanism of injury, vehicle speed, height of fall, time elapsed from inj ury until arrival at the ED, transport method, prehospital analgesic u se, mortality, Injury Severity Score, and initial ED vital signs, Glas gow Coma Scale, Trauma Score, and Pediatric Trauma Score. Fifty-nine p ercent (ten of 17) of the children with associated internal injuries l imited to the chest or abdomen received analgesics compared with 62% ( 33 of 53) in those with isolated fracture (P=.8). Those with an associ ated head injury (31%, nine of 29) received analgesics less frequently than those with isolated fracture (62%, 33 of 53) (P=.01).