Poor Access to Timely Pain Reduction Interventions for Pediatric Patients With Supracondylar Humerus Fracture

Objective: The purpose of this study was to describe the use of analgesic interventions in children with acute supracondylar fractures presenting to a pediatric emergency department (ED) and to explore the relationship between timely interventions and severity of injury. Methods: This was a retrospective cohort study. Structured chart reviews were conducted on all eligible cases of acute supracondylar humerus fracture presenting to a single pediatric ED over a 5-year period ending in December 2009. Two interventions were studied: administration of a systemic analgesic and placement of an immobilizing backslab. Criteria for timeliness were administration of an analgesic within 30 minutes from triage and placement of a backslab before radiography. Cases were dichotomized as nonsevere or severe based on whether the fracture was treated with casting alone or with another orthopedic intervention (closed reduction in the ED or any procedure in the operating room). Results: Of 160 eligible cases, 116 were classified as nonsevere and 44 as severe. The proportions receiving a timely analgesic were 3% and 11%, respectively, in these groups (P = 0.04 for difference). For backslab application, 16% and 61% received timely treatment in the nonsevere and severe groups, respectively (P = 0.000 for difference). Conclusions: Children presenting to a pediatric ED with a painful injury had low access to early systemic analgesics and backslab immobilization. Many factors may have played a role, including lack of mandated documentation of a formal pain score and lack of a medical directive allowing triage nurses to administer analgesics in the institution studied.