Open Access Open Access  Restricted Access Subscription Access

Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review


Affiliations
1 University of Montreal, Montreal, QC, H3T 1A8, Canada
2 Women and Children’s Health Research Institute, Edmonton, AB, T6G 1C9, Canada
3 Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee,WI 53226, United States
4 CHU Sainte-Justine Research Centre, Montreal, QC, H3T 1C5, Canada
5 CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5, Canada
6 Children’s Hospital, London Health Sciences Centre, London, ON, N6A 5W9, Canada
 

Background: Painmanagement for children withmusculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective: To systematically reviewthe most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods: Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0-18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results: Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions: Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.
User
Notifications
Font Size

Abstract Views: 125

PDF Views: 0




  • Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review

Abstract Views: 125  |  PDF Views: 0

Authors

Sylvie Le May
University of Montreal, Montreal, QC, H3T 1A8, Canada
Samina Ali
Women and Children’s Health Research Institute, Edmonton, AB, T6G 1C9, Canada
Christelle Khadra
University of Montreal, Montreal, QC, H3T 1A8, Canada
Amy L. Drendel
Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee,WI 53226, United States
Evelyne D. Trottier
CHU Sainte-Justine Research Centre, Montreal, QC, H3T 1C5, Canada
Serge Gouin
CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5, Canada
Naveen Poonai
Children’s Hospital, London Health Sciences Centre, London, ON, N6A 5W9, Canada

Abstract


Background: Painmanagement for children withmusculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective: To systematically reviewthe most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods: Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0-18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results: Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions: Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.