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Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes
  1. Sarah R Martin1,2,3,
  2. Theodore W Heyming3,4,
  3. Michelle A Fortier2,5,6,
  4. Zeev N Kain1,2,7,8
  1. 1Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Irvine, California, USA
  2. 2Center on Stress & Health, University of California, Irvine, Orange, CA, USA
  3. 3Emergency Medicine, Children's Hospital of Orange County, Orange, California, USA
  4. 4Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
  5. 5Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
  6. 6Psychology, Children's Hospital of Orange County, Orange, California, USA
  7. 7Children's Hospital of Orange County, Orange, California, USA
  8. 8Yale University Child Study Center, New Haven, CT, USA
  1. Correspondence to Dr Sarah R Martin, Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Irvine, CA 92868, USA; sarahm7{at}hs.uci.edu

Abstract

Background Paediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This study examined post-discharge recovery following paediatric laceration repair in the ED.

Methods This prospective observational study included a convenience sample of 173 children 2–12 years old undergoing laceration repair in a paediatric ED in Orange, California, USA between April 2022 and August 2023. Demographics, laceration and treatment data (eg, anxiolytic medication), and caregiver-reported child pre-procedural and procedural pain (Numerical Rating Scale (NRS)) were collected. On days 1, 3, 7 and 14 post-discharge, caregivers reported children’s pain and new-onset maladaptive behavioural changes (eg, separation anxiety) via the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery. Univariate and logistic regression analyses were conducted to identify variables associated with the incidence of post-discharge maladaptive behavioural change.

Results Post-discharge maladaptive behavioural changes were reported in 43.9% (n=69) of children. At 1 week post-discharge, approximately 20% (n=27) of children exhibited maladaptive behavioural changes and 10% (n=13) displayed behavioural changes 2 weeks post-discharge. Mild levels of pain (NRS ≥2) were reported in 46.7% (n=70) of children on post-discharge day 1, 10.3% (n=14) on day 7 and 3.1% (n=4) on day 14. An extremity laceration (p=0.029), pre-procedural midazolam (p=0.020), longer length of stay (p=0.043) and post-discharge pain on day 1 (p<0.001) were associated with incidence of maladaptive behavioural changes. Higher pain on post-discharge day 1 was the only variable independently associated with an increased likelihood of maladaptive behavioural change (OR=1.32 (95% CI 1.08 to 1.61), p=0.001).

Conclusion Over 40% of children exhibited maladaptive behavioural changes after ED discharge. Although the incidence declined over time, 10% of children continued to exhibit behavioural changes 2 weeks post-discharge. Pain on the day following discharge emerged as a key predictor, highlighting the potential critical role of proactive post-procedural pain management in mitigating adverse behavioural changes.

  • pediatric emergency medicine
  • pediatric injury
  • pain management

Data availability statement

Data are available upon reasonable request. The de-identified datasets analysed during the current study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The de-identified datasets analysed during the current study are available from the corresponding author upon reasonable request.

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Footnotes

  • Handling editor Shammi L Ramlakhan

  • X @sarahraemartin

  • Contributors SRM, TWH, MAF and ZNK each made substantial contributions to the conception or design of the work and the acquisition, analysis or interpretation of data for the work. SRM drafted the manuscript, and all authors revised the draft manuscript critically for important intellectual content and interpretation of data. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SRM is responsible for the overall content as guarantor and accepts full responsibility for the finished work and conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding SRM is supported by the National Institutes of Health National Institute for Child Health and Human Development (K23HD105042, PI: SRM).

  • Competing interests ZNK serves as a consultant for Edwards Lifesciences and Mend and is the president of the American College of Perioperative Medicine.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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