The Relationship Between Patient Age and Pain Management of Long Bone Fracture in the Emergency Department

BackgroundIn November 2003, the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (JC) developed common quality performance measures that could be applied across all accredited health organizations. Proposed emergency department (ED) measures for 2013 include Median Time to Pain Management for Long Bone Fracture. While the metric has not yet been defined, we speculate that compliance will be determined by pain medication administration (narcotic or non-narcotic analgesic) within 60 min of arrival time.Previous studies have shown that there may be inadequate pain management among patients with long bone fracture (LBF) presenting to the ED. Certain patient populations, especially pediatric (<18 years) and geriatric (≥65 years), may be unable to communicate their needs effectively; as a result, these patient groups may not be receiving appropriate pain management in the ED.Study ObjectiveThe purpose of this study is to determine if there are differences in pain management for LBF amongst age groups (pediatric, adult, and geriatric) presenting to the emergency department.MethodsThis study was a retrospective chart review of a consecutive sample of subjects presenting to the ED of a suburban, university-affiliated hospital with acute LBF between April 1, 2012 and December 31, 2012. Patients who received pain medication prior to arrival or who presented with chronic LBF pain were excluded. Subject age, arrival time (triage time), whether pain medication was administered, and time to initial pain medication administration were recorded. Subjects were categorized into 3 groups based on age: pediatric (<18 years), adult (≥18 - <65 years), and geriatric (≥65 years).Statistical MethodsA single factor analysis of variance (ANOVA) was used to determine if there is a difference in time to pain medication administration between the three age groups (pediatric, adult, and geriatric). In analyzing the time differences between two groups, independent, two-tailed Student's t-tests were performed between the following groups: pediatric/adult, pediatric/geriatric, and adult/geriatric. A Bonferroni correction was used to account for the multiple comparisons.ResultsA total of 818 patients were included. 171 (21.6%), 269 (32.9%), and 378 (46.2%) were categorized as pediatric, adult, and geriatric, respectively. One hundred thirty-one (76.6%) pediatric, 226 (84%) adult, and 297 (78.6%) geriatric patients received pain medication during their ED stay (Table 1). The ANOVA analysis indicated that there was a significant difference in time to pain medication administration between the age groups (p=4.214E-08) (Table 2). Student's t-test analysis showed that there were significant differences between pediatric and geriatric groups (p=7.988E-07) and adult and geriatic groups (p= 1.674E-05). There was no statistical difference between the pediatric and adult groups (Table 3).ConclusionTable 1Pain Management of Long Bone Fracture between Age GroupsPediatricAdultGeriatricAverage Age (years)8.5145.381.4Total Number Patients171269378Percent Received Pain Medication (%)76.684.078.6Average Time to Pain Medication (min)49.157.378.0Median Time to Pain Medication (min)40.040.060.0Standard Deviation (min)38.447.961.0 Open table in a new tab Table 2Single Factor ANOVA Analysis of Time to Medication and Age GroupSource of VariationSSDfMSFP-valueF critBetween Age Groups9674024837017.434.214E-083.009 Open table in a new tab Table 32 Tailed, Student's T-Test Analysis of Time to Medication and Age GroupAge Groups ComparedP-ValuePediatric – Adult0.0929Pediatric – Geriatric7.988E-07Adult – Geriatric1.674E-05 Open table in a new tab BackgroundIn November 2003, the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (JC) developed common quality performance measures that could be applied across all accredited health organizations. Proposed emergency department (ED) measures for 2013 include Median Time to Pain Management for Long Bone Fracture. While the metric has not yet been defined, we speculate that compliance will be determined by pain medication administration (narcotic or non-narcotic analgesic) within 60 min of arrival time.Previous studies have shown that there may be inadequate pain management among patients with long bone fracture (LBF) presenting to the ED. Certain patient populations, especially pediatric (<18 years) and geriatric (≥65 years), may be unable to communicate their needs effectively; as a result, these patient groups may not be receiving appropriate pain management in the ED. In November 2003, the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (JC) developed common quality performance measures that could be applied across all accredited health organizations. Proposed emergency department (ED) measures for 2013 include Median Time to Pain Management for Long Bone Fracture. While the metric has not yet been defined, we speculate that compliance will be determined by pain medication administration (narcotic or non-narcotic analgesic) within 60 min of arrival time. Previous studies have shown that there may be inadequate pain management among patients with long bone fracture (LBF) presenting to the ED. Certain patient populations, especially pediatric (<18 years) and geriatric (≥65 years), may be unable to communicate their needs effectively; as a result, these patient groups may not be receiving appropriate pain management in the ED. Study ObjectiveThe purpose of this study is to determine if there are differences in pain management for LBF amongst age groups (pediatric, adult, and geriatric) presenting to the emergency department. The purpose of this study is to determine if there are differences in pain management for LBF amongst age groups (pediatric, adult, and geriatric) presenting to the emergency department. MethodsThis study was a retrospective chart review of a consecutive sample of subjects presenting to the ED of a suburban, university-affiliated hospital with acute LBF between April 1, 2012 and December 31, 2012. Patients who received pain medication prior to arrival or who presented with chronic LBF pain were excluded. Subject age, arrival time (triage time), whether pain medication was administered, and time to initial pain medication administration were recorded. Subjects were categorized into 3 groups based on age: pediatric (<18 years), adult (≥18 - <65 years), and geriatric (≥65 years). This study was a retrospective chart review of a consecutive sample of subjects presenting to the ED of a suburban, university-affiliated hospital with acute LBF between April 1, 2012 and December 31, 2012. Patients who received pain medication prior to arrival or who presented with chronic LBF pain were excluded. Subject age, arrival time (triage time), whether pain medication was administered, and time to initial pain medication administration were recorded. Subjects were categorized into 3 groups based on age: pediatric (<18 years), adult (≥18 - <65 years), and geriatric (≥65 years). Statistical MethodsA single factor analysis of variance (ANOVA) was used to determine if there is a difference in time to pain medication administration between the three age groups (pediatric, adult, and geriatric). In analyzing the time differences between two groups, independent, two-tailed Student's t-tests were performed between the following groups: pediatric/adult, pediatric/geriatric, and adult/geriatric. A Bonferroni correction was used to account for the multiple comparisons. A single factor analysis of variance (ANOVA) was used to determine if there is a difference in time to pain medication administration between the three age groups (pediatric, adult, and geriatric). In analyzing the time differences between two groups, independent, two-tailed Student's t-tests were performed between the following groups: pediatric/adult, pediatric/geriatric, and adult/geriatric. A Bonferroni correction was used to account for the multiple comparisons. ResultsA total of 818 patients were included. 171 (21.6%), 269 (32.9%), and 378 (46.2%) were categorized as pediatric, adult, and geriatric, respectively. One hundred thirty-one (76.6%) pediatric, 226 (84%) adult, and 297 (78.6%) geriatric patients received pain medication during their ED stay (Table 1). The ANOVA analysis indicated that there was a significant difference in time to pain medication administration between the age groups (p=4.214E-08) (Table 2). Student's t-test analysis showed that there were significant differences between pediatric and geriatric groups (p=7.988E-07) and adult and geriatic groups (p= 1.674E-05). There was no statistical difference between the pediatric and adult groups (Table 3). A total of 818 patients were included. 171 (21.6%), 269 (32.9%), and 378 (46.2%) were categorized as pediatric, adult, and geriatric, respectively. One hundred thirty-one (76.6%) pediatric, 226 (84%) adult, and 297 (78.6%) geriatric patients received pain medication during their ED stay (Table 1). The ANOVA analysis indicated that there was a significant difference in time to pain medication administration between the age groups (p=4.214E-08) (Table 2). Student's t-test analysis showed that there were significant differences between pediatric and geriatric groups (p=7.988E-07) and adult and geriatic groups (p= 1.674E-05). There was no statistical difference between the pediatric and adult groups (Table 3). ConclusionTable 1Pain Management of Long Bone Fracture between Age GroupsPediatricAdultGeriatricAverage Age (years)8.5145.381.4Total Number Patients171269378Percent Received Pain Medication (%)76.684.078.6Average Time to Pain Medication (min)49.157.378.0Median Time to Pain Medication (min)40.040.060.0Standard Deviation (min)38.447.961.0 Open table in a new tab Table 2Single Factor ANOVA Analysis of Time to Medication and Age GroupSource of VariationSSDfMSFP-valueF critBetween Age Groups9674024837017.434.214E-083.009 Open table in a new tab Table 32 Tailed, Student's T-Test Analysis of Time to Medication and Age GroupAge Groups ComparedP-ValuePediatric – Adult0.0929Pediatric – Geriatric7.988E-07Adult – Geriatric1.674E-05 Open table in a new tab