Pediatric Fracture-Related Pain: The Crowding Effect

According to published studies, pain is the most common reason for seeking care in the ED, accounting for up to 78% of visits. Underuse of analgesics is common, especially among pediatric patients. There are many reasons that contribute to this problem, but key themes have emerged as culprits, says Marion R. Sills, MD, MPH. “Studies have found that higher crowding levels appear to delay treatment of pain in adult patients who visit the ED, but little research has been conducted in pediatric populations. The effect of ED crowding on children is growing as a research priority.” The Pediatric Population & ED  Crowding For adults, crowding has been associated with decreased quality across all six Institute of Medicine (IOM) quality dimensions: timeliness, effectiveness, equity, patient-centeredness, safety, and efficiency. In an effort to address these dimensions in the context of crowding in ED pediatric patients, Dr. Sills and colleagues conducted a study involving children with acute long-bone fracture-related pain who visited an ED (see also, ED Crowding: The Impact on Child Asthma Care). “Extremity fractures are among the most common reasons children seek ED care, resulting in 850,000 ED visits nationwide each year,” adds Dr. Sills. “These fractures can be especially painful for children.” The study by Dr. Sills and colleagues, which was published in the December 2011 issue of Academic Emergency Medicine, measured the association between ED crowding and the quality of pain management for children with long-bone fractures. The objective was explored in three of the IOM’s six dimensions of quality: effectiveness, timeliness, and equity. The research team measured the dose-response effect of ED crowding on quality by comparing quality...