The relationship between patient age and pain management of acute long-bone fracture in the ED

Boccio, Eric; Wie, Benjamin; Pasternak, S.; Salvador-Kelly, A.; Ward, M.F.; D’Amore, Jason

doi:10.1016/j.ajem.2014.09.025

Cited by 10 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Second, our study finds, when LBF and SBF were examined separately, no differences were found in the likelihood of analgesic administration between older and younger patients on adjusted analyses. However, consistent with previous single-site studies, older patients had slightly longer analgesic wait times (15 minutes) [5]. This time difference may be due to age-related disparities in pain care or because clinicians are more restrained when ordering medications for older patients.…”

Section: Discussionsupporting

confidence: 74%

“…Although several prior studies have investigated fracture pain treatment disparities in older adults, few have examined treatment across different types of fracture [5,10]. Older adults are more likely to present with LBF.…”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating age-related disparities in fracture pain care have yielded conflicting results. While several smaller studies have noted that older patients with specific fractures were at increased risk of oligoanalgesia compared to younger patients [5,10,11], they have been limited to long bone fractures (LBF). The few studies on fracture pain care in the ED have been limited to a single center and single fracture type, have had a small cohort, and/ or were poorly controlled for confounders [5,10,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…While several smaller studies have noted that older patients with specific fractures were at increased risk of oligoanalgesia compared to younger patients [5,10,11], they have been limited to long bone fractures (LBF). The few studies on fracture pain care in the ED have been limited to a single center and single fracture type, have had a small cohort, and/ or were poorly controlled for confounders [5,10,[12][13][14]. A recent multicenter study by Hwang et al in 2014 [7] on all fractures made the surprising discovery that older patients with fractures were more likely to receive analgesics and opioids, and had better self-reported pain outcomes than younger patients.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have found that oligoanalgesia is common in the ED, caused by both delays to analgesic administration and under administration of analgesic doses [4,5]. Older patients are thought to be particularly exposed to risk of oligoanalgesia because of poor ability to self-advocate and system-level (and potentially provider-level) age bias [6].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

et al. 2016

View full text Add to dashboard Cite

Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.Design. Secondary analysis of retrospective cohort study. Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type.Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR 5 2.03; 95 CI 5 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate 5 0.268; 95 CI 5 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P 5 0.057), but no other differences in process outcomes were found.Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.

show abstract

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

et al. 2016

View full text Add to dashboard Cite

show abstract

Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Timely analgesia is critical for children with injuries presenting to the emergency department, yet pain control efforts are often inadequate. Intranasal administration of pain medications provides rapid analgesia with minimal discomfort. Opioids are historically used for significant pain from traumatic injuries but have concerning adverse effects. Intranasal ketamine may provide an effective alternative. OBJECTIVE To determine whether intranasal ketamine is noninferior to intranasal fentanyl for pain reduction in children presenting with acute extremity injuries. DESIGN, SETTING, AND PARTICIPANTS The Pain Reduction With Intranasal Medications for Extremity Injuries (PRIME) trial was a double-blind, randomized, active-control, noninferiority trial in a pediatric, tertiary, level 1 trauma center. Participants were children aged 8 to 17 years presenting to the emergency department with moderate to severe pain due to traumatic limb injuries between March 2016 and February 2017. Analyses were intention to treat and began in May 2017. INTERVENTIONS Intranasal ketamine (1.5 mg/kg) or intranasal fentanyl (2 μg/kg). MAIN OUTCOMES AND MEASURES The primary outcome was reduction in visual analog scale pain score 30 minutes after intervention. The noninferiority margin for this outcome was 10. RESULTS Of 90 children enrolled, 45 (50%) were allocated to ketamine (mean [SD] age, 11.8 [2.6] years; 26 boys [59%]) and 45 (50%) to fentanyl (mean [SD] age, 12.2 [2.3] years; 31 boys [74%]). Thirty minutes after medication, the mean visual analog scale reduction was 30.6 mm (95% CI, 25.4-35.8) for ketamine and 31.9 mm (95% CI, 26.6-37.2) for fentanyl. Ketamine was noninferior to fentanyl for pain reduction based on a 1-sided test of group difference less than the noninferiority margin, as the CIs crossed 0 but did not cross the prespecified noninferiority margin (difference in mean pain reduction between groups, 1.3; 90% CI, −6.2 to 8.7). The risk of adverse events was higher in the ketamine group (relative risk, 2.5; 95% CI, 1.5-4.0), but all events were minor and transient. Rescue analgesia was similar between groups (relative risk, 0.89; 95% CI, 0.5-1.6). CONCLUSIONS AND RELEVANCE Ketamine provides effective analgesia that is noninferior to fentanyl, although participants who received ketamine had an increase in adverse events that were minor and transient. Intranasal ketamine may be an appropriate alternative to intranasal fentanyl for pain associated with acute extremity injuries. Ketamine should be considered for pediatric pain management in the emergency setting, especially when opioids are associated with increased risk.

show abstract

Genomics of Fracture Pain

Griffioen

Dorsey

Renn

2020

Genomics of Pain and Co-Morbid Symptoms

View full text Add to dashboard Cite

The relationship between patient age and pain management of acute long-bone fracture in the ED

Cited by 10 publications

References 16 publications

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children

Genomics of Fracture Pain

Contact Info

Product

Resources

About