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Unscheduled Evaluation or Advice for Poorly Controlled Pediatric Fracture Pain – A Cross-Sectional Study

Kopp, Tara M, M.D.
http://orcid.org/0000-0001-9509-4377
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563295890995465

Abstract Details

2019, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Objectives: To define the proportion of pediatric patients that seek medical advice or evaluation for poorly controlled fracture pain, identify factors associated with an increased likelihood of requesting assistance, and explore caregiver opioid preferences for fracture pain management. Methods: We performed a cross-sectional study of a convenience sample of 251 children and their caregivers presenting to the orthopedic surgery clinic in a tertiary care children’s hospital. Children 5–17 years old presenting within 10 days of injury for follow-up for a single extremity, non-operative long bone fracture(s) were eligible. Participants completed a survey and then a retrospective chart review was performed. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain prior to the first routine follow-up appointment by one or more of the following 4 methods: (1) call to the primary provider, orthopedic surgery, emergency department (ED) or urgent care (UC), or other family-defined expert; (2) ED or UC visit; (3) scheduling a visit with the primary provider; (4) rescheduling to an earlier orthopedic surgery clinic appointment. Factors associated with the primary outcome were assessed using bi-variable analysis via Wilcoxon rank sum test for continuous data and Chi-square or Fisher’s exact test for categorical variables. Results: Overall, 7.3% (18/245) of participants sought unscheduled evaluation or advice for poorly controlled pain. The two most common reasons for seeking help were to obtain over-the-counter (OTC) medication dosage information (64.7%) or a stronger analgesic (29.4%). Children who sought evaluation or advice for poorly controlled pain were more likely to be Hispanic or Latino (16.7% vs 2.2%, p=0.0319), have a leg fracture (44.4% vs 14.5%, p=0.0014), or have a fracture that was overriding (16.7% vs 4.4%, p=0.0255), translated (50.0% vs 16.7%, p=0.0006), or required manual reduction (50.0% vs 18.9%, p=0.0021) under conscious sedation (44.4% vs 16.0%, p=0.0028). Furthermore, these children had higher PROMIS Pain Behavior Scores (4.4 difference, p=0.0058), higher PROMIS Pain Interference Scores (8.4 difference, p<0.001), and more anxious caregivers (22.2% vs 6.6%, p=0.0171). One-third of caregivers expressed hesitancy or refusal to use opioid medications to treat their child’s severe pain, of which 45.7% reported potential addiction or abuse as the rationale. Conclusions: A small, but significant, proportion of patients seek additional advice or evaluation for poorly controlled pain after discharge with a single extremity, non-operative long bone fracture(s). Medical providers should give thorough discharge instructions for fracture pain management at home, including detailed OTC medication dosage information. Caregivers should be engaged in shared decision-making if providers believe opioid medications may be required for severe pain at home, since a significant proportion of caregivers are hesitant due to fear of addiction or abuse.
Aimin Chen, Ph.D. (Committee Chair)
Terri L. Byczkowski, Ph.D. M.B.A. (Committee Member)
Matthew Mittiga (Committee Member)
31 p.
Surgery
pediatric fracture pain; pediatric

Recommended Citations

Citations

  • Kopp, M.D., T. M. (2019). Unscheduled Evaluation or Advice for Poorly Controlled Pediatric Fracture Pain – A Cross-Sectional Study [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563295890995465

    APA Style (7th edition)

  • Kopp, M.D., Tara. Unscheduled Evaluation or Advice for Poorly Controlled Pediatric Fracture Pain – A Cross-Sectional Study. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563295890995465.

    MLA Style (8th edition)

  • Kopp, M.D., Tara. "Unscheduled Evaluation or Advice for Poorly Controlled Pediatric Fracture Pain – A Cross-Sectional Study." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563295890995465

    Chicago Manual of Style (17th edition)

ucin1563295890995465
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This open access ETD is published by University of Cincinnati and OhioLINK.