Crowded emergency departments deliver less effective pain relief for pediatric patients with fractures

Sills MR. Acad Emerg Med. 2011. doi: 10.1111/j.1553-2712.2011.01136.x.

Crowding in emergency departments has led to a decrease in the timely and effective use of pain medication in children suffering acute long bone fractures, according to a study published in Academic Emergency Medicine.

"Pain associated with long bone fractures can be pretty severe," lead author Marion Sills, MD, MPH, stated in a University of Colorado press release. "But crowded emergency departments are impacting the delivery of care on many levels, including the delivery of pain medication."

Sills and colleagues performed a cross-sectional retrospective study of 1,229 patients — up to age 21 — treated in a 1 year period for acute, isolated long-bone fractures in the emergency department of an academic children's hospital. They took timeliness and effectiveness of treatment into account in their research, with emergency department occupancy as the primary independent variable.

According to their results, patients were 4% to 47% less likely to receive timely care and 3% to 17% less likely to receive effective care when crowding measures were at the 90th percentile rather than the 10th percentile. Three of the six quality measures that researchers examined showed a "steep" decline in quality between the 75th and 90th crowding percentiles, according to the study abstract.

Five previous studies showed that crowded emergency rooms lead to lower levels of pain control among adult patients. But this was the first time researchers investigated the impact of crowding on children with fracture-related pain, according to the release.

"We found that crowding can lower the likelihood of timely treatment by as much as 47% and raise the likelihood of non-treatment by as much as 17%," Sills stated in the release. "The relationship between emergency department crowding and pain treatment is not unexpected. When the emergency department gets busier, staff may be less responsive to the needs of individual patients, and as a result, patients have a higher likelihood of non-treatment and delays in treatment."

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