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Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study
  1. Giorgio Cozzi1,
  2. Luisa Cortellazzo Wiel2,
  3. Anna Bassi2,
  4. Manuela Giangreco1,
  5. Daniela Dibello3,
  6. Marco Rozzo1,
  7. Valentina Di Carlo1,
  8. Maria Rita Lucia Genovese2,
  9. Egidio Barbi1,2
  1. 1Department of Paediatrics, Institute for Maternal and Child Health—IRCCS 'Burlo Garofolo', Trieste, Italy
  2. 2Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
  3. 3UOC Orthopedics and Traumatology, Giovanni XXIII Pediatric Hospital, Bari, Italy
  1. Correspondence to Dr Luisa Cortellazzo Wiel, Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34127, Italy; luisacortellazzowiel{at}gmail.com

Abstract

Background Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables.

Methods A prospective observational cross-sectional study was conducted at the ED of the children’s hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0–17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ2 or Fisher’s exact tests were used to assess secondary outcomes.

Results During the study period, 213 patients, mean age 10 years (IQR: 8–13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child’s age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).

Conclusion Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.

  • analgesia/pain control
  • musculoskeletal
  • fractures and dislocations
  • paediatric emergency med
  • paediatrics
  • paediatric orthopaedics
  • pain management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. No additional information is available.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. No additional information is available.

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Footnotes

  • Handling editor Shammi L Ramlakhan

  • Contributors GC conceptualised and supervised the work and is the guarantor of the work. DD, MR, VDC and MRLG recruited participants. AB performed patients’ follow-up and collected the questionnaires. MG was responsible for the statistical analysis of data. LCW wrote the first draft of the manuscript. EB revised and edited the final version of the manuscript. All the authors approved the final version of the manuscript and take full responsibility for its contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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