Comparing Emergency Department Pain Management Practices for Pediatric Musculoskeletal Injuries 

Musculoskeletal (MSK) injuries requiring a visit to the Emergency Department (ED) are common in children and often associated with moderate to severe pain. Despite this, identification and management of pediatric pain remains a considerable challenge. This study examines analgesic practices among children with MSK injuries presenting to three Saskatchewan EDs.

All patients aged 0-17 with acute MSK injuries between 2022 and 2024 at the Regina General Hospital (RGH), Pasqua Hospital (PH), and Jim Pattison Children’s Hospital (JPCH) were identified. Chart reviews were conducted and demographics, triage, diagnosis, pain assessment, and analgesia were collected. Primary outcomes included ED analgesic use and time to first dose. Site comparisons used chi-square and Kruskal-Wallis tests.

Among 600 patients (200 per site), 49.7% received ED analgesia, varying by site (JPCH 65%, PH 48%, RGH 36%; p<0.001). Median time to first analgesic was shortest at JPCH (3 minutes) versus PH (55 minutes) and RGH (26 minutes) (p<0.001). JPCH triaged more patients as lower acuity and had the shortest median length of stay (p<0.001). Pre-treatment pain assessment was documented least frequently at JPCH (p<0.001).

Significant differences in analgesia use and timeliness exist across Saskatchewan EDs, with the pediatric ED providing faster, more frequent pain treatment.