P092: Caregiver perspectives on children's functional outcomes following fracture: a qualitative study

Introduction: Fractures are a common childhood presentation to the emergency department (ED). While ED providers are aware of treating pain, we are less aware of the functional impact of these fractures. Eighty percent of children with a fracture experience compromise in their daily function. Understanding the functional outcomes of fractures will help optimize discharge instructions for at-home care. The primary objective of our study was to describe caregivers' perspectives on the impact of their child's fracture on: (1) child functioning, (2) caregiver functioning and (3) family life. Methods: We performed a qualitative study interviewing caregivers of children (5 to 11 years) who received care for acute (< 24 hours old), non-operative long bone fractures at a Canadian tertiary care pediatric ED. Audio-recorded, semi-structured telephone interviews were completed 1-2 weeks post-ED visit, until thematic saturation was achieved. Transcripts were read and coded by two researchers concurrent with data collection. We applied content analysis to the interview material, explicating themes to summarize the data utilizing NVivo software. Results: Twenty-five interviews were completed. Most children (23/25) suffered upper extremity fractures and most participants were mothers (21/25). All caregivers reported a change in their child's function. The most commonly affected areas included: sleep, play and activities of daily living (ADL's; ie. dressing, bathing, eating). Children were impacted by pain and related negative emotional responses. All children required additional help from their caregivers to carry out ADL's. Strategies included changing household routines and missing work. Importantly, caregivers described a disrupted family dynamic. Adapting to their injured child's functional deficits and caring for pain and distress took time and attention away from the household's previously well-functioning routine. This burden was felt by all family members. Key concerns from caregivers included pain management, fracture healing/complications, and regression of their child's independence. Conclusion: Function is universally impaired in younger children with fractures. We suggest 5 main points to include in discharge instructions: (1) monitoring pain and providing analgesia, (2) helping children with ADL's, even if previously independent, (3) allotting extra time for morning and bedtime routines, (4) offering safe choices for play and (5) coaching children in positive thinking and problem-solving.