Comparison of Acetaminophen With Codeine and Ibuprofen for Children With Injuries

Inclusion Criteria: * 5 to 18 years of age * Spoke English as a primary language * Complained of an extremity injury with tenderness to palpation from the clavicle or femoral neck to the distal phalanges * Scored 5 or greater on a 10-point ordinal or Varni-Ryan pain scale administered at triage Exclusion Criteria: * Allergy or prior adverse reaction to acetaminophen, codeine or ibuprofen; * Administration of any analgesic within 6 hours of presentation; * Significant deformity or vascular insufficiency of the extremity requiring immediate treatment as determined by the treating physician; * Inability to use the study pain instrument; * Any laceration near the suspected injury; * Chronic hepatic or renal disease; * Pregnancy in the third trimester; * Concurrent use of contraindicated medications such as monoamine oxidase inhibitors; or * Use of central nervous system depressants such as ethanol, benzodiazepines, barbiturates, antidepressants, or recreational drugs