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: 9764396
• 负责人: Amy L Drendel
• 金额: $ 58.24万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9764396
• 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; Clinical; Clinical Trials; 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 environment; 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; Text Messaging; Treatment Protocols; clinically relevant; comparative effectiveness; effectiveness research; evidence base; experience; functional outcomes; health related quality of life; improved; injured children; long bone; mHealth; medical attention; member; mortality; non-opioid analgesic; opioid abuse; opioid sparing; pain reduction; patient oriented; pediatric emergency; prescription opioid; prospective; repository

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，疼痛的治疗是以患者为中心的基本目标。骨折疼痛治疗 孩子们不一致，常常不足。没有明确的证据表明哪个通常 使用的药物在临床上最有效。对长骨的最佳疼痛治疗没有共识 骨折，完全使用止痛药的药物中存在可变性。 治疗不足的疼痛与功能降低和与健康相关的生活质量降低有关。然而， 阿片类药物滥用的流行导致过量，事故和死亡的发生率提高。这种二分法 对提供者为儿童做出明智的，负责任的处方决定和 已经导致使用的药物可变化。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 对骨折疼痛儿童的最佳治疗方法的共识。 我们将进行一项前瞻性的多中心，纵向比较有效性研究，该研究大写 疼痛治疗中已知的可变性，以确定最有效的建议的镇痛治疗方案 急诊室和家里有骨折疼痛的孩子。我们将使用已建立的多中心存储库 所有急诊科（ED）访问收集的电子健康记录数据，六个卫生系统， 代表了超过500,000名儿童的年度人口普查。这些数据将与移动健康链接 前瞻性收集有关疼痛，功能结果和不良影响的信息的解决方案 出院后使用电子技术。结合使用，该建议将比较患者特定的疼痛 通过医院到家的连续护理体验数据，以确定最佳实践。 我们的长期目标是改善受伤儿童的小儿疼痛的治疗。总体目标 研究是为所有急性儿童评估并提供ED和ED后疼痛治疗的证据 与骨折有关的疼痛。独特的这项研究前瞻性地跟踪了从ED访问到家的全部患者体验。 直接比较现有的疼痛管理策略和相关的短期患者结果 将定义最有效的急性疼痛管理实践。