Home Use of Nonpharmacologic Interventions For Fracture Pain After Pediatric Emergency Department Discharge.
Publication/Presentation Date
11-1-2025
Abstract
BACKGROUND: Nonpharmacologic (physical and psychological) interventions are recommended for the treatment of acute pain after pediatric emergency department (PED) discharge. Frequency of use and relation to analgesia and patient characteristics have not been well described.
OBJECTIVES: We aimed to determine the types and duration of nonpharmacologic interventions, describe their relationship with analgesic use, and identify clinically relevant associated variables.
METHODS: This was a secondary analysis of a multi-site prospective observational cohort study of children aged 4-17 years discharged from 7 PEDs July 2019 through September 2021 with an isolated long bone fracture. Parents/guardians reported nonpharmacologic interventions and analgesic use via daily text messaging.
RESULTS: 1,819 children were included. During the first week after PED discharge, 96% used nonpharmacologic interventions at least 1 day, with distraction and elevation being the most frequently and consistently used. Only 3% reported using analgesia alone during the first week, while the proportion using only nonpharmacologic interventions tripled from 9% to 27%. Children aged 11-13 years had increased likelihood of nonpharmacologic use compared to those aged 4-7 years (OR 3.7 95% CI [1.4, 9.8]). Children with moderate to severe pain at discharge were also more likely to use nonpharmacologic interventions (OR 2.1 [95% CI 1.1, 3.9]).
CONCLUSIONS: Children with long bone fractures used nonpharmacologic interventions more frequently and for a longer duration than analgesic medications. Increasing age and pain severity at discharge were associated with greater use. Interventional studies are needed to provide evidence-informed recommendations for these interventions after PED discharge.
Volume
78
First Page
202
Last Page
213
ISSN
0736-4679
Published In/Presented At
Wiersma, A. J., Nielsen, B., Webb, M., Alpern, E., Brousseau, D. C., Chamberlain, J. M., Zorc, J. J., Babcock, L., Frey, T., Leonard, J. C., Ali, S., Barney, B. J., Drendel, A. L., & PECARN IMPROVE and PECARN Registry Study Groups (2025). Home Use of Nonpharmacologic Interventions For Fracture Pain After Pediatric Emergency Department Discharge. The Journal of emergency medicine, 78, 202–213. https://doi.org/10.1016/j.jemermed.2025.08.018
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40992346
Department(s)
Administration and Leadership
Document Type
Article