Home Use of Nonpharmacologic Interventions For Fracture Pain After Pediatric Emergency Department Discharge

BACKGROUND: Nonpharmacologic (physical and psychological) interventions are recommended for the treatment of acute pain after pediatric emergency department (PED) discharge. Frequency of use and relation to analgesia and patient characteristics have not been well described.

OBJECTIVES: We aimed to determine the types and duration of nonpharmacologic interventions, describe their relationship with analgesic use, and identify clinically relevant associated variables.

METHODS: This was a secondary analysis of a multi-site prospective observational cohort study of children aged 4-17 years discharged from 7 PEDs July 2019 through September 2021 with an isolated long bone fracture. Parents/guardians reported nonpharmacologic interventions and analgesic use via daily text messaging.

RESULTS: 1,819 children were included. During the first week after PED discharge, 96% used nonpharmacologic interventions at least 1 day, with distraction and elevation being the most frequently and consistently used. Only 3% reported using analgesia alone during the first week, while the proportion using only nonpharmacologic interventions tripled from 9% to 27%. Children aged 11-13 years had increased likelihood of nonpharmacologic use compared to those aged 4-7 years (OR 3.7 95% CI [1.4, 9.8]). Children with moderate to severe pain at discharge were also more likely to use nonpharmacologic interventions (OR 2.1 [95% CI 1.1, 3.9]).

CONCLUSIONS: Children with long bone fractures used nonpharmacologic interventions more frequently and for a longer duration than analgesic medications. Increasing age and pain severity at discharge were associated with greater use. Interventional studies are needed to provide evidence-informed recommendations for these interventions after PED discharge.