330 - At-home administration of opioid analgesia in children discharged from the emergency department after reduction of forearm fracture

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 330
Publication Number: 330.208

Ariel B. Stein, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Shea Lammers, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Henry Ortega, Childrens Minnesota, Minneapolis, MN, United States; Samuel R.. Reid, Children's Minnesota, St. Paul, MN, United States

Presenting Author(s)

Ariel B. Stein, MD (she/her/hers)

Fellow
Children's Hospitals and Clinics of Minnesota
Minneapolis, Minnesota, United States

Background: Controversy exists surrounding which agents are best for providing adequate analgesia in children with fractures. Prior studies have demonstrated that Emergency Department (ED) visits for fracture related pain, particularly those with radius fractures, have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent and may be superior to opioids at controlling pain associated with acute fractures. In a time when one must balance the risk of inadequate pain control in children with the risk of potential opioid misuse and abuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home.

Objective: We seek to better understand pain management practices at home after discharge from the emergency department in children with forearm fractures requiring sedated reduction.

Design/Methods: We conducted a prospective observational study. Pre-discharge questionnaires completed by research assistants and post-discharge follow up surveys filled out by parents were used to gather data on the proportion of children discharged with an opioid prescription, the number of doses of opioid medication that were administered by parents after discharge, and parental satisfaction with the adequacy of their child’s pain control. Data analysis was completed using student T-test, Chi square and descriptive statistics.

Results:

We analyzed data for 62 patients who completed the post-discharge survey. Of these, 39 (62.9%) received a prescription for oxycodone at discharge. Thirty-two (82%) of the 39 families filled the prescription for oxycodone and of those, 19 (59.4%) used at least 1 dose of oxycodone at home. The mean number of doses administered at home (1.68 ±1.74) was significantly lower than the mean number of doses prescribed (11.06±7.27), p= < 0.001. Additionally, families who received a prescription for oxycodone (4.64 ± 0.49) trended toward a significantly higher satisfaction than those who did not (4.29 ±0.94), p= 0.06.

Conclusion(s): Significant variability exists in opioid prescribing patterns even amongst providers in the same ED group. We observed a large range in the number of doses prescribed at discharge and a significant difference between the number of doses being prescribed and those being used by families. Of families who received an opioid prescription at discharge, the majority used at least one dose of this medication to control their child’s pain and there was a trend towards higher satisfaction in pain control for those families who received a prescription for an opioid medication at home.