The Effect of Emergency Department and After-Emergency Department Analgesic Treatment on Pediatric Long Bone Fracture Outcomes

急诊科和急诊科术后镇痛治疗对小儿长骨骨折预后的影响

• 批准号: 10410483
• 负责人: Amy L Drendel
• 金额: $ 54.79万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10410483
• 关键词: 18 year old; Absenteeism at work; Accident and Emergency department; Accidents; Acute; Acute Pain; Acute pain management; Address; Adult; Adverse effects; Aftercare; Analgesics; Applied Research; Cellular Phone; Censuses; Cessation of life; Characteristics; Child; Childhood; Childhood Injury; Clinical; Clinical Trials; Comparative Effectiveness Research; Consensus; Continuity of Patient Care; Data; Data Sources; Electronic Health Record; Emergency Care; Emergency department visit; Epidemic; Family; Fracture; Goals; Health Care Costs; Health Personnel; Health system; Healthcare; Home; Hospitals; Incidence; Injury; Institute of Medicine (U.S.); Link; Methodology; Morbidity - disease rate; Opioid; Opioid Analgesics; Outcome; Outpatients; Overdose; Pain; Pain management; Parents; Patient-Focused Outcomes; Patients; Performance; Persistent pain; Pharmaceutical Preparations; Positioning Attribute; Practice Management; Prospective Studies; Provider; Quality of life; Recommendation; Recording of previous events; Regimen; Technology; Testing; Text Messaging; Treatment Protocols; abuse liability; clinically relevant; comparative effectiveness study; digital repositories; evidence base; experience; functional outcomes; health related quality of life; improved; long bone; mHealth; medical attention; member; mortality; non-opioid analgesic; opioid abuse; opioid sparing; pain reduction; patient oriented; pediatric emergency; prescription opioid; prescription pain reliever; prospective

ABSTRACT Treatment of pain is an essential patient-centered goal for all healthcare providers. Fracture pain treatment for children is inconsistent and often inadequate. There is no clear evidence demonstrating which of the commonly used medications are most clinically effective. With no consensus on the best pain treatment for long bone fractures, there remains variability in medication utilized or inconsistent use of analgesic altogether. Undertreated pain is associated with reduced function and decreased health related quality of life. However, the opioid abuse epidemic has resulted in increasing rates of overdose, accidents and death. This dichotomy poses a serious challenge for providers making informed, responsible prescription decisions for children and has resulted in significant variability in the medications utilized. This variability in practice will allow us to examine clinically relevant outcomes associated with the various treatment regimens to facilitate reaching consensus for the best treatment for children with fracture pain. We will perform a prospective multi-center, longitudinal comparative effectiveness study that capitalizes on the known variability in pain treatment to determine the most effective recommended analgesic regimen for children with fracture pain in the ED and at home. We will use an established multi-center repository of electronic health record data collected for all Emergency Department (ED) visits at six health systems, representing a combined annual census of over 500,000 children. These data will be linked to a mobile health solution that prospectively collects information about pain, functional outcomes and adverse effects from families after discharge using e-technology. In combination, this proposal will compare patient-specific pain experience data over the continuum of care from the hospital to the home to determine best practice. Our long-term goal is to improve the treatment of pediatric pain for injured children. The overall goal of this study is to evaluate and provide evidence for both ED and post-ED pain treatment for all children with acute fracture-related pain. Uniquely, this study prospectively tracks the full patient experience from ED visit to home. The direct comparison of existing pain management strategies and the associated short-term patient outcomes will define the most effective acute pain management practice.

抽象的 对于所有医疗保健提供者来说，疼痛治疗是以患者为中心的基本目标。骨折疼痛治疗 孩子们的表现不一致，而且往往不够充分。没有明确的证据表明哪些是常见的 使用的药物在临床上最有效。对于长骨的最佳疼痛治疗方法尚未达成共识 骨折时，所使用的药物仍然存在差异，或者镇痛药的使用不一致。 疼痛治疗不足与功能下降和健康相关生活质量下降有关。然而， 阿片类药物滥用流行导致用药过量、事故和死亡率不断上升。这种二分法 对提供者为儿童和儿童做出明智、负责任的处方决定提出了严峻的挑战 导致所用药物的显着变化。实践中的这种可变性将使我们能够 检查与各种治疗方案相关的临床相关结果，以促进达到 关于儿童骨折疼痛最佳治疗的共识。 我们将进行一项前瞻性多中心、纵向比较有效性研究，利用 已知疼痛治疗的变异性，以确定最有效的推荐镇痛方案 在急诊室和家里有骨折疼痛的儿童。我们将使用已建立的多中心存储库 为六个卫生系统的所有急诊科 (ED) 就诊收集的电子健康记录数据， 代表超过 500,000 名儿童的年度人口普查。这些数据将链接到移动健康 前瞻性地收集有关疼痛、功能结果和不良反应的信息的解决方案 出院后的家庭使用电子技术。结合起来，该提案将比较患者特定的疼痛 从医院到家庭的连续护理过程中的经验数据，以确定最佳实践。 我们的长期目标是改善受伤儿童的儿科疼痛治疗。本次活动的总体目标 研究旨在评估所有患有急性勃起障碍的儿童的 ED 和 ED 后疼痛治疗并提供证据 骨折相关的疼痛。独特的是，这项研究前瞻性地跟踪了从急诊室到家的完整患者体验。 现有疼痛管理策略和相关短期患者结果的直接比较 将定义最有效的急性疼痛管理实践。

项目成果

Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures.

骨折儿童急诊出院时的阿片类药物处方模式。

• 发表时间: 2020
• 作者: Drendel, Amy L;Brousseau, David C;Casper, T Charles;Bajaj, Lalit;Alessandrini, Evaline A;Grundmeier, Robert W;Chamberlain, James M;Goyal, Monika K;Olsen, Cody S;Alpern, Elizabeth R
• 通讯作者: Alpern, Elizabeth R