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Eltorki M, Rezk E, El-Dakhakhni W, Freedman SB, Drendal A, Ali S. Trends and Factors Associated With Pediatric Opioid Use in Emergency Departments. Pediatrics 2024:e2023065614. [PMID: 38779784 DOI: 10.1542/peds.2023-065614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Mohamed Eltorki
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Faculty of Health Sciences
| | - Eman Rezk
- School of Computational Science and Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Wael El-Dakhakhni
- School of Computational Science and Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Stephen B Freedman
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Drendal
- Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry and Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
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Snyder AB, Zhou M, Attell BK, Cohen LL, Carter S, Bock F, Dampier C. Opioid Use After First Opioid Prescription in Children With Sickle Cell Disease. JAMA Pediatr 2024; 178:408-410. [PMID: 38372994 PMCID: PMC10877502 DOI: 10.1001/jamapediatrics.2023.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/01/2023] [Indexed: 02/20/2024]
Abstract
This cohort study assesses the level of opioid use, number of vaso-occlusive crises, and days’ supply of opioids among opioid-naive pediatric patients.
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Affiliation(s)
| | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, Atlanta
| | | | | | - Sierra Carter
- Psychology Department, Georgia State University, Atlanta
| | - Fiona Bock
- Georgia Health Policy Center, Georgia State University, Atlanta
| | - Carlton Dampier
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Belardo ZE, Talwar D, Blumberg TJ, Nelson SE, Upasani VV, Sankar WN, Shah AS. Opioid Analgesia Compared with Non-Opioid Analgesia After Operative Treatment for Pediatric Supracondylar Humeral Fractures: Results from a Prospective Multicenter Trial. J Bone Joint Surg Am 2023; 105:1875-1885. [PMID: 37956188 PMCID: PMC10695340 DOI: 10.2106/jbjs.23.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Minimal pain and opioid use after operative treatment for pediatric supracondylar humeral fractures have been previously described; however, opioid-prescribing practices in the United States remain variable. We hypothesized that children without an opioid prescription would report similar postoperative pain compared with children prescribed opioids following closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures. METHODS Children who were 3 to 12 years of age and were undergoing CRPP for a closed supracondylar humeral fracture were prospectively enrolled in a multicenter, comparative study. Following a standardized dosing protocol, oxycodone, ibuprofen, and acetaminophen were prescribed at 2 hospitals (opioid cohort), and 2 other hospitals prescribed ibuprofen and acetaminophen alone (non-opioid cohort). The children's medication use and the daily pain that they experienced (scored on the Wong-Baker FACES Scale) were recorded at postoperative days 1 to 7, 10, 14, and 21, using validated text-message protocols. Based on an a priori power analysis, at least 64 evaluable subjects were recruited per cohort. RESULTS A total of 157 patients were evaluated (81 [52%] in the opioid cohort and 76 [48%] in the non-opioid cohort). The median age at the time of the surgical procedure was 6.2 years, and 50% of the subjects were male. The mean postoperative pain scores were low overall (<4 of 10), and there were no significant differences in pain ratings between cohorts at any time point. No patient demographic or injury characteristics were correlated with increased pain or medication use. Notably, of the 81 patients in the opioid cohort, 28 (35%) took no oxycodone and 40 (49%) took 1 to 3 total doses across the postoperative period. Patients rarely took opioids after postoperative day 2. A single patient in the non-opioid cohort (1 [1%] of 76) received a rescue prescription of opioids after presenting to the emergency department with postoperative cast discomfort. CONCLUSIONS Non-opioid analgesia following CRPP for pediatric supracondylar humeral fractures was equally effective as opioid analgesia. When oxycodone was prescribed, 84% of children took 0 to 3 total doses, and opioid use fell precipitously after postoperative day 2. To improve opioid stewardship, providers and institutions can consider discontinuing the routine prescription of opioids following this procedure. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Zoe E. Belardo
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Divya Talwar
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Todd J. Blumberg
- Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Susan E. Nelson
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | | | - Wudbhav N. Sankar
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Apurva S. Shah
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Kalmar CL, Zapatero ZD, Kosyk MS, Swanson JW, Taylor JA. Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter? Cleft Palate Craniofac J 2023; 60:1157-1165. [PMID: 35437063 DOI: 10.1177/10556656221093945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To analyze whether the choice of intraoperative local anesthetic for cleft lip repair is associated with the amount of perioperative narcotic utilization. Retrospective cohort study. Hospitals participating in the Pediatric Health Information System. Primary cleft lip repairs performed in the United States from 2010 to 2020. Local anesthesia injected-treatment with lidocaine alone, bupivacaine alone, or treatment with both agents. Perioperative narcotic administration. During the study interval, 8954 patients underwent primary cleft lip repair. Narcotic utilization for unilateral (P < .001) and bilateral (P = .004) cleft lip repair has decreased over the last 5 years. Overall, 21.8% (n = 1950) of infants were administered perioperative narcotics for cleft lip repair, such that 14.3% (n = 1282) required narcotics on POD 0, and 7.2% (n = 647) required narcotics on POD 1.In this study, 36.5% (n = 3269) patients received lidocaine, 22.0% (n = 1966) patients received bupivacaine, and 19.7% (n = 1762) patients received both local anesthetics. Administration of any perioperative narcotic was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P = .001, 17.5% vs 21.7%) or only bupivacaine (P < .001, 17.5% vs 22.9%). Narcotic utilization on the day of surgery was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P < .001, 11.5% vs 15.1%) or only bupivacaine (P = .004, 11.5% vs 14.6%). Narcotic utilization on the first postoperative day was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only bupivacaine (P = .009, 5.9% vs 8.1%). CONCLUSIONS In children undergoing cleft lip repair, local anesthetic combination of lidocaine and bupivacaine is associated with decreased perioperative narcotic use compared to lidocaine or bupivacaine alone.
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Affiliation(s)
- Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary D Zapatero
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mychajlo S Kosyk
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Sivaraj LB, Truong K, Basco WT. Racial/Ethnic Patterns in Opioid Dispensing among Medicaid-Funded Young Children. Healthcare (Basel) 2023; 11:1910. [PMID: 37444744 DOI: 10.3390/healthcare11131910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Racial differences in opioid dispensing for diseases of the respiratory system (RESP) and injury (INJURY) outpatient visits among patients ≤ 3 years old were examined. Outpatient claims data of South Carolina Medicaid children were analyzed over three three-year periods. The variable of interest was the triennial rate of dispensed opioid prescriptions per 1000 visits for RESP and INJURY diagnoses across racial/ethnic groups. Overall, dispensed opioid prescription rates related to RESP declined for all racial/ethnic categories. White children had the highest dispensing rate for RESP indications in the first period (5.6), followed by Black (4.5), and Hispanic (4.1). The likelihood of White children being prescribed opioids was higher than Blacks, and this was persistent over the studied time (rate ratios from 1.24 to 1.22, respectively). Overall opioid dispensing rates related to injury declined during the studied time. Hispanics had the highest dispensing rate for INJURY (20.1 to 14.8 to 16.1, respectively) followed by White (16.1 to 13.1 to 10.4, respectively). Relative differences in the dispensing rates across groups increased over time (Hispanics vs. White: rate ratios from 1.25 to 1.55, Hispanics vs. Black: from 1.52 to 2.24, and White vs. Black: from 1.24 to 1.44, respectively). There are considerable differences in the dispensing rates across racial/ethnic groups, especially in injury-related prescribing.
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Affiliation(s)
- Laksika B Sivaraj
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
- Addiction Medicine Center, Prisma Health, Greenville, SC 29601, USA
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - William T Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
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Basco WT, Bundy DG, Garner SS, Ebeling M, Simpson KN. Annual Prevalence of Opioid Receipt by South Carolina Medicaid-Enrolled Children and Adolescents: 2000-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095681. [PMID: 37174201 PMCID: PMC10178489 DOI: 10.3390/ijerph20095681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/15/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Understanding patterns of opioid receipt by children and adolescents over time and understanding differences between age groups can help identify opportunities for future opioid stewardship. We conducted a retrospective cohort study, using South Carolina Medicaid data for children and adolescents 0-18 years old between 2000-2020, calculating the annual prevalence of opioid receipt for medical diagnoses in ambulatory settings. We examined differences in prevalence by calendar year, race/ethnicity, and by age group. The annual prevalence of opioid receipt for medical diagnoses changed significantly over the years studied, from 187.5 per 1000 in 2000 to 41.9 per 1000 in 2020 (Cochran-Armitage test for trend, p < 0.0001). In all calendar years, older ages were associated with greater prevalence of opioid receipt. Adjusted analyses (logistic regression) assessed calendar year differences in opioid receipt, controlling for age group, sex, and race/ethnicity. In the adjusted analyses, calendar year was inversely associated with opioid receipt (aOR 0.927, 95% CI 0.926-0.927). Males and older ages were more likely to receive opioids, while persons of Black race and Hispanic ethnicity had lower odds of receiving opioids. While opioid receipt declined among all age groups during 2000-2020, adolescents 12-18 had persistently higher annual prevalence of opioid receipt when compared to younger age groups.
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Affiliation(s)
- William T Basco
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC 29425, USA
| | - David G Bundy
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC 29425, USA
| | - Sandra S Garner
- Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, The Medical University of South Carolina, Charleston, SC 29425, USA
| | - Myla Ebeling
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kit N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, The Medical University of South Carolina, Charleston, SC 29425, USA
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Sivaraj LBM, Basco WT, Heavner SF, Lopes SS, Rolke LJ, Shi L, Truong K. Outpatient Opioid Dispensing Patterns for SC Medicaid Children 1-36 Months Old. Matern Child Health J 2023; 27:1043-1050. [PMID: 36939951 DOI: 10.1007/s10995-023-03621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES We sought to identify the most common diagnostic categories linked to dispensed opioid prescriptions among children 1-36 months old and changes in patterns over the years 2000 to 2017. METHODS This study used South Carolina's Medicaid claims data of pediatric dispensed outpatient opioid prescriptions between 2000 and 2017. The major opioid-related diagnostic category (indication) for each prescription was identified using visit primary diagnoses and the Clinical Classification System (AHRQ-CCS) software. The variables of interest were the rate of opioid prescriptions per 1,000 visits for each diagnostic category and the relative percentage of opioid prescriptions assigned to each category compared to all categories. RESULTS Six major diagnostic categories were identified; Diseases of the respiratory system (RESP), Congenital anomalies (CONG), Injury (INJURY), Diseases of the nervous system and sense organs (NEURO), Diseases of the digestive system (GI), and Diseases of the genitourinary system (GU). The overall rate of dispensed opioid prescriptions per category declined significantly for four diagnostic categories throughout the study period, RESP by 15.13, INJURY by 8.49, NEURO by 7.33, and GI by 5.93. Two categories increased during the same time, CONG (by 9.47) and GU (by 6.98). RESP was the most prevalent category linked to a dispensed opioid prescription within 2010-2012 (almost 25%) but CONG was the most prevalent by 2014 (17.77%). CONCLUSIONS FOR PRACTICE Among Medicaid children 1-36 months old, annual dispensed opioid prescription rates declined for most major diagnostic categories (RESP, INJURY, NEURO, and GI). Future studies should explore alternatives to current opioid dispensing practices for GU and CONG cases.
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Affiliation(s)
| | - William T Basco
- Department of Pediatrics, The Medical University of South Carolina, Charleston, SC, USA
| | - Smith F Heavner
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.,CURE Drug Repurposing Collaboratory Critical Path Institute, Tucson, Arizona, USA.,Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, USA
| | - Snehal S Lopes
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Laura J Rolke
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
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Hauser Chatterjee J, Hartford EA, Law E, Barry D, Blume H. Sumatriptan as a First-Line Treatment for Headache in the Pediatric Emergency Department. Pediatr Neurol 2023; 142:68-75. [PMID: 36958085 DOI: 10.1016/j.pediatrneurol.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/23/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Headache is a common presenting condition for patients seen in the pediatric emergency department (ED). Intranasal (IN) sumatriptan is a well-tolerated and safe abortive treatment for migraine headache, but it is infrequently administered in pediatric EDs. In this study we characterize an ED migraine pathway that uses IN sumatriptan as a first-line treatment. METHODS We performed retrospective chart analysis from a single center, reviewing a cohort of patients treated on an ED migraine pathway between October 2016 and February 2020. We reviewed patient demographics, clinical characteristics, treatment patterns, change in pain scores, sumatriptan prescriptions at discharge, length of stay (LOS), ED charges, and unexpected return visits. RESULTS A total of 558 patients (aged six to 21 years, 66% female) were included in this study. Overall, the median pretreatment pain score was 7 (interquartile range [IQR]: 5 to 8) and the median post-treatment pain score was 2 (IQR: 0 to 4). Forty-eight percent of patients received IN sumatriptan in the ED, and 36% of those who received sumatriptan were prescribed oral sumatriptan at discharge. When intravenous (IV) access was obtained for headache management, this was associated with a significantly longer LOS and higher ED charges. CONCLUSIONS IN sumatriptan shows promise as a feasible and potentially effective first-line treatment for pediatric migraine in the ED that could reduce the need for IV therapies, shorten LOS, and lower ED charges. Further research is needed to determine the efficacy of IN sumatriptan relative to other common first-line therapies used to treat pediatric migraine in the ED.
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Affiliation(s)
- Jessica Hauser Chatterjee
- Division of Child Neurology, Department of Neurology, University of Washington School of Medicine and the Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington.
| | - Emily A Hartford
- Department of Pediatric Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Emily Law
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Dwight Barry
- Clinical Analytics, Seattle Children's Hospital, Seattle, Washington
| | - Heidi Blume
- Division of Child Neurology, Department of Neurology, University of Washington School of Medicine and the Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington
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Langham J, Holmes S, Figueroa J, Iyer S, Lazarus S, Gillespie S, Sulton C. Physician self-identified race and opioid prescription practices in upper extremity injuries in the pediatric emergency department. Heliyon 2023; 9:e13351. [PMID: 36814623 PMCID: PMC9939590 DOI: 10.1016/j.heliyon.2023.e13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Background Minority children have been shown to receive fewer opioid analgesics for acute pain. Objective Assess if both White and non-White physicians prescribe fewer opioids to non-White children presenting to the pediatric emergency department (PED) with upper extremity (UE) fractures. Methods Patients with acute UE fractures were evaluated. Attending physicians provided their self-identified race and consented to analysis of their opioid prescribing practices. Primary outcome was receipt of an opioid prescription at discharge. Bivariate analyses measured the association between patient race and receipt of an opioid prescription; further analysis evaluated the effect of physician race on prescription practices. Generalized linear models measured these associations while controlling for confounders. Results Thirty-four percent of eligible patients (2754/8155) were discharged with an opioid prescription. There was no statistically significant difference in odds of being discharged with an opioid prescription for non-Hispanic Black (NHB) compared to non-Hispanic White (NHW) patients. There was no statistically significant difference in odds of prescribing opioids by both White physicians and non-White physicians. In patients with the most severe fractures, requiring sedation for reduction, NHB patients had lower odds of receiving an opioid prescription (OR 0.80; 95% CI: 0.65-0.98). Conclusion Within our institution, NHB patients received fewer opioid prescriptions at discharge for UE fractures. There is no statistically significant association between NHB race and odds of receiving an opioid prescription. In patients sedated for fracture reductions, NHB patients had lower odds of receiving an opioid prescription and non-White physicians had lower odds of prescribing opioids to NHB patients compared to NHW patients.
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Affiliation(s)
- Joseph Langham
- Emory University School of Medicine, Pediatric Emergency Medicine, Atlanta, GA, USA
- Corresponding author. Emory University School of Medicine, Pediatric Emergency Medicine, Atlanta, GA 404-210-5657, USA.
| | - Sherita Holmes
- Emory University School of Medicine, Pediatric Emergency Medicine, Atlanta, GA, USA
| | | | - Srikant Iyer
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Lazarus
- Pediatric Emergency Medicine Physician, Atlanta, GA, USA
| | | | - Carmen Sulton
- Emory University School of Medicine, Pediatric Emergency Medicine, Atlanta, GA, USA
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Begley BB, Cerniglia KS, Aboelatta MM, Begum L, Gilbert G, Mathew J, Meixner SR, Franklin CC, Ramirez RN. Race, Gender, and Primary Language Were Not Associated With Changes in Opioid Prescribing in Children: Results From a Single Institution, 2010 to 2020. Clin Orthop Relat Res 2023; 481:338-344. [PMID: 36125497 PMCID: PMC9831194 DOI: 10.1097/corr.0000000000002414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients should be prescribed medication based on their medical condition, without prejudice because of their race, gender, or primary language. However, previous research has shown that men are prescribed more medication than women, patients who are White are prescribed more medications than patients who are non-White, and English-speaking people are prescribed more medications than non-English-speaking patients. However, it is unclear whether these differences also occur in pediatric orthopaedic populations. QUESTIONS/PURPOSES We asked: (1) Was the amount of opiates prescribed at discharge associated with patient age, gender, race, or primary language? (2) Did the amount of opiates prescribed to patients at discharge change from 2010 to 2020? METHODS In a single center, between January 2010 and December 2019, we treated 331 patients younger than 18 years surgically for upper and lower long-bone extremity fractures. Patients were considered eligible if they had a nonpathologic fracture. Femur fractures were not included. Based on these criteria, all patients were eligible. The mean age was 12 ± 4 years. The mean weight was 57 ± 33 kg. Among these patients, 76% (253 of 331) were boys and 24% (78 of 331) were girls. From the hospital discharge records, we recorded the amount of opiates prescribed at the time of discharge as measured by morphine milligram equivalents (MMEs). We examined the association of age, gender, race, primary language, weight, and year of treatment using this measurement. We determined a patient's race retrospectively by information given by their parents at time of admission. We did not attempt to contact patients to obtain more nuanced information about their racial background. These data were obtained from the electronic health record. The Wilcoxon rank sum test, t-test, or chi-square test was used to assess associations depending on the distribution of variables, as appropriate. Because opioids as measured in MMEs is zero-inflated, a two-part model analysis was used to adjust for confounding variables. One component of the model was for the probability of having any opiate prescription and another was for the mean number of opioids received. Findings were considered statistically significant if p values were < 0.05. RESULTS In total, 57% (189 of 331) of children were prescribed opiates at discharge after surgery for long-bone fractures. Opiate MMEs increased with patient age (r = 0.38; p < 0.01). Boys and girls showed no difference in the amounts of pain medication (adjusted odds ratio [OR] 1.38 [95% confidence interval (CI) 0.80 to 2.39]; p = 0.71; adjusted opioid difference: 0.35 MME [95% CI -51.7 to 52.4]; p = 0.99), nor were there differences between patients who were White and those who were non-White (adjusted OR 0.78 [95% CI 0.49 to 1.23]; p = 0.28; adjusted opioid difference: 21.5 MME [95% CI -19.3 to 62.4]; p = 0.30), or between patients for whom English was there primary language and those for whom English was not their primary language (adjusted OR 1.16 [95% CI 0.52 to 2.57]; p = 0.71; adjusted opioid difference: 22.7 MME [95% CI -55.7 to 101.3]; p = 0.57) when adjusted for age and weight. There was no change in opioid prescription amounts from 2010 to 2020 after adjusting for changes in patient age across years (Spearman r = -0.08; p = 0.16). CONCLUSION Fairness in opioid prescribing based on race, gender, or primary language is possible. Additional research is needed to determine what factors in our institution led to this result. We suggest that prescribers should apply consistent protocols based on factors such as weight or injury type rather than making individual decisions for each patient. This will lead to fairer opioid prescribing to patients from different race and gender groups. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | | | - Lubna Begum
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Grace Gilbert
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Justin Mathew
- Cooper Medical School at Rowan University, Camden, NJ, USA
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Characterizing opioid prescribing to adolescents at time of discharge from a pediatric hospital over a five-year period. J Pediatr Nurs 2022; 66:104-110. [PMID: 35709633 DOI: 10.1016/j.pedn.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To characterize opioid prescribing over a 5-year period to adolescents upon discharge from one urban pediatric medical center. DESIGN AND METHODS A retrospective cross-sectional analysis of 4354 adolescents discharged with a pain medication after an admission of ≤5 days between January 2015 and December 2019 was performed. Two outcome groups, based on the analgesics prescribed at discharge, were compared: those discharged with a prescription for a non-opioid only and those discharged with an opioid prescription. The association between year of discharge and receipt of opioid, while adjusting for relevant demographic and clinical characteristics, was also explored. RESULTS Approximately 64% of the sample was discharged with an opioid prescription. Of those, the median daily dosage was 45.0 morphine milligram equivalents (MME) [IQR: 32.4, 45.0]. Year of discharge was associated with decreased odds of receiving an opioid when adjusting for age, race, sex, insurance, pain scores, opioid exposure during hospitalization, length of stay, and undergoing surgery. The odds of being discharged with an opioid decreased each year by 29% (Adjusted Odds Ratio [AOR] = 0.71, CI:0.68-0.73). Concurrently, the proportion of patients discharged with nonopioid pain medication increased from 25% of adolescent patients in 2015 to 50% in 2019. CONCLUSIONS Overall, opioid prescribing to adolescents at time of discharge decreased over time in our sample. PRACTICE IMPLICATIONS While prescribing has decreased opioid analgesics are dispensed to young patients. Risk of opioid use disorder and overdose is rare in this population, but adolescence is good opportunity for nursing to promote safe prescribing and analgesic use.
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Ruskin D, Rasul R, McCann-Pineo M. Predictors of Emergency Department Opioid Use Among Adolescents and Young Adults. Pediatr Emerg Care 2022; 38:e1409-e1416. [PMID: 35686972 PMCID: PMC9351695 DOI: 10.1097/pec.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach. METHODS We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively. RESULTS There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73-7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14-4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37-0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI, 4.24-8.25), in addition to tooth pain (OR, 5.47; 95% CI, 3.84-7.69). CONCLUSIONS Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.
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Krakow AR, Talwar D, Mehta NN, Gandhi JS, Flynn JM. Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents. J Bone Joint Surg Am 2022; 104:1166-1171. [PMID: 35793795 DOI: 10.2106/jbjs.21.01078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Opioids constitute the fastest-growing drug problem among children and adolescents in the United States. Recent heavy media coverage on the opioid prescription epidemic has garnered increased attention from prescribers and policymakers. The purpose of this study was to analyze trends in opioid prescribing for nonoperatively managed pediatric fractures and dislocations in order to examine changes in opioid-prescribing patterns across various U.S. regions. METHODS A retrospective review of the national Pediatric Health Information System (PHIS) database comprising 42 pediatric hospitals was performed to identify pediatric fractures and dislocations presenting to the emergency department (ED) or outpatient clinics from 2004 to 2017. We included patients with the 10 most frequently encountered diagnoses who were nonoperatively managed and were discharged home the same day. To account for hospital variation, we utilized a mixed-effects logistic regression model. RESULTS The final cohort included 134,931 patients, with a mean age (and standard deviation) of 12.57 ± 2.00 years (range, 10 to 18 years); 69.23% of patients were male. Overall, 51.69% of patients were prescribed at least 1 opioid dose during their ED or clinic visits. Of the patients receiving opioids, 72.04% were male and 54.10% were insured through a private insurance plan. When prescription trends were compared according to regions, children were more likely to be prescribed opioids in the South (71.37% more likely) and the Midwest (26.17% more likely) than in the Northeast. CONCLUSIONS Although the opioid prescription rates in all 4 regions have decreased dramatically over the years, some regions were quicker than others in responding to the opioid epidemic. A significant interregional variability in opioid-prescribing practices still exists, but an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis. CLINICAL RELEVANCE Opioid-related misuse is a national epidemic and reducing the use of opioids in pediatric orthopaedic procedures is critical. Although regional variability in opioid-prescribing practices still exists, an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.
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Affiliation(s)
- Arielle R Krakow
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nishank N Mehta
- Department of Orthopaedics, Stony Brook University, Stony Brook, New York
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Wynia EH, Lowing DM, Pan EJ, Schrock JW. Shifting practice in pediatric prescription opioid use in the emergency department for fractures. Am J Emerg Med 2022; 59:141-145. [DOI: 10.1016/j.ajem.2022.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022] Open
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15
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Shaw RE, Staffa SJ, Nasr VG, Tung C. Impact of Parental Primary Spoken Language on Postoperative Pain Management in Children, a Retrospective Cohort Study. CHILDREN 2022; 9:children9050739. [PMID: 35626916 PMCID: PMC9139688 DOI: 10.3390/children9050739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022]
Abstract
Background: Healthcare providers encounter varying languages every day in patient care. The goal of this study was to examine whether a difference exists in pain scoring and treatment amongst pediatric patients whose families’ primary language was not English. We hypothesized that patients of both Arabic-speaking (AS) and Spanish-speaking (SS) backgrounds received higher pain scores and higher daily opioid equivalents (OEs) postoperatively compared to English-speaking (ES) patients. Methods: This was a retrospective cohort study of patients undergoing surgery for treatment of various esophageal and airway disorders from 2014 to 2019. Records were queried for patients undergoing thoracotomies for treatment of esophageal and airway disorders. Analysis was focused on the three most common languages in this selected population: English, Arabic, and Spanish. Propensity score matching was utilized for comparisons of pain scores between AS, SS, and ES patient groups. Primary outcomes were opioid equivalents (OEs) and pain scores postoperatively. Multivariable median regression analysis was used to perform an adjusted comparison of pain scores as well as OEs. Results: A total of 610 patient encounters were included in our analysis. In propensity matched analysis, there were no significant differences in OEs between all groups postoperatively. However, statistically significant higher pain scores were reported in the ES group matched AS groups. Conclusions: Language differences did not lead to difference in pain assessment and treatment.
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Affiliation(s)
- Robert E. Shaw
- Division of Pediatric Anesthesia, Department of Anesthesiology, University of Wisconsin, Madison, WI 53792, USA
- Correspondence:
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (V.G.N.); (C.T.)
| | - Viviane G. Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (V.G.N.); (C.T.)
| | - Cynthia Tung
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (V.G.N.); (C.T.)
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Dispensed Opioid Prescription Patterns, by Racial/Ethnic Groups, Among South Carolina Medicaid-Funded Children Experiencing Limb Fracture Injuries. Acad Pediatr 2022; 22:631-639. [PMID: 35257927 DOI: 10.1016/j.acap.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/13/2022] [Accepted: 02/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine dispensed opioid prescription patterns for limb fractures across racial/ethnic groups in a pediatric population. METHODS We used South Carolina's Medicaid claims data 2000 to 2018 for pediatric limb fracture cases (under age 19) discharged from the emergency department. The key independent variable was the child's race/ethnicity. The outcomes were: 1) whether the patient had a dispensed opioid prescription; and 2) whether dispensed opioid supply was longer than 5 days among cases with any dispensed opioid prescriptions. Logistic regression models were used to test the association between race/ethnicity and the outcomes. Covariates included age-at-service, gender, service year, and having multiple fracture injuries. RESULTS Compared with non-Hispanic White cases (NHW), the odds of receiving dispensed opioid prescriptions were lower for cases of non-Hispanic Black (NHB) (OR = 0.73; 95% confidence interval [CI]: 0.71, 0.75), Asian (OR = 0.69; CI: 0.53, 0.90), Other/Unknown (OR = 0.86; CI: 0.80, 0.92), and Hispanic (OR = 0.84; CI: 0.79, 0.90) race/ethnicity. The odds of receiving >5 days of dispensed opioid prescription supply did not differ significantly among race/ethnic categories. CONCLUSIONS Our study confirms previous findings that as compared to NHW, the NHB children were less likely to receive dispensed opioid prescriptions. Also, it reveals that the different minority race/ethnic groups are not homogenous in their likelihoods of receiving dispensed opioid prescriptions after a limb fracture compared to NHW, findings underreported in previous studies. Children in the Other/Unknown race/ethnicity category have prescribing patterns different from those of other minority race/ethnic groups and should be analyzed separately.
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Chua WJ, Groenewald CB, Varakitsomboon S, Harris J, Faino AV, Quan L, Walco GA, Sousa TC. Can Use of Default Dispensing Quantities in Electronic Medical Record Lower Opioid Prescribing? Pediatr Emerg Care 2022; 38:e600-e604. [PMID: 35100763 PMCID: PMC9269031 DOI: 10.1097/pec.0000000000002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Leftover opioids can contribute to misuse and abuse. Recommended dosing quantities in the electronic medical record can guide prescribing patterns. We hypothesized that decreasing the default from 30 doses to 12 doses would decrease the overall number of opioids prescribed without increasing second opioid prescriptions or additional health utilization. METHODS We performed a single-center retrospective study of children with forearm and elbow fractures who presented to the emergency department for evaluation and subsequent orthopedic follow-up between January 15, and September 19, 2017. The default dispensing quantity was decreased on June 1, 2016 from 30 doses to 12 doses. Patients were categorized to preintervention and postintervention groups. We compared the number of opioids prescribed, second opioid prescriptions, emergency department visits, and pain-related telephone calls and orthopedic visits with χ2 and logistic regression analyses. RESULTS There were 1107 patients included. Rates of opioid prescribing were similar preintervention and postintervention (61% vs 56%, P = 0.13). After the change to the default quantity, the median number of doses decreased from 18 to 12 doses, with opioid prescriptions of 30 or more doses dropping from 35% to 11%. No significant association was found between preintervention versus postintervention, opioid prescription at discharge, and having 1 or more pain-related or unexpected follow-up visits. CONCLUSIONS Lowering the default dispensing quantity of opioids in the electronic medical record decreases the number of opioids prescribed without increasing second prescriptions or additional health care utilization. These findings suggest that a further reduction in the number of opioids prescribed for upper-extremity fractures may be possible.
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Affiliation(s)
- Wee-Jhong Chua
- Division of Emergency Medicine, Department of Pediatrics, North-western University Feinberg School of Medicine
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Cornelius B. Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
- Department of Pediatrics, Seattle Children’s Hospital
| | - Shing Varakitsomboon
- Department of Pediatrics, Seattle Children’s Hospital
- Department of Orthopedics and Sports Medicine, University of Washington School of Medicine
| | - Jacob Harris
- Department of Pediatrics, Seattle Children’s Hospital
- Department of Orthopedics and Sports Medicine, University of Washington School of Medicine
| | - Anna V. Faino
- Department of Pediatrics, Seattle Children’s Hospital
- Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, WA
| | - Linda Quan
- Department of Pediatrics, Seattle Children’s Hospital
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Gary A. Walco
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
- Department of Pediatrics, Seattle Children’s Hospital
| | - Ted C. Sousa
- Department of Orthopedics, Shriners Hospitals for Children-Spokane, Spokane, WA
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Choufi S, Mounier S, Merlin E, Rochette E, Delorme J, Authier N, Chenaf C. Opioid Analgesic Prescription in French Children: A National Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13316. [PMID: 34948923 PMCID: PMC8702064 DOI: 10.3390/ijerph182413316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.
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Affiliation(s)
- Samira Choufi
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (S.C.); (S.M.); (E.M.)
| | - Simon Mounier
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (S.C.); (S.M.); (E.M.)
| | - Etienne Merlin
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (S.C.); (S.M.); (E.M.)
- CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (S.C.); (S.M.); (E.M.)
- CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Jessica Delorme
- CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, F-63003 Clermont-Ferrand, France; (J.D.); (N.A.); (C.C.)
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, F-63003 Clermont-Ferrand, France; (J.D.); (N.A.); (C.C.)
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, F-63001 Clermont-Ferrand, France
| | - Chouki Chenaf
- CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, F-63003 Clermont-Ferrand, France; (J.D.); (N.A.); (C.C.)
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, F-63001 Clermont-Ferrand, France
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Wang GS, Reese J, Bakel LA, Leonard J, Bos T, Bielsky A, Nickels S, Bajaj L. Prescribing Patterns of Oral Opioid Analgesic for Long Bone Fracture at Tertiary Care Children's Hospital Emergency Departments and Urgent Cares. Pediatr Emerg Care 2021; 37:e1524-e1527. [PMID: 32384393 DOI: 10.1097/pec.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Disparities in opioid prescribing in children can lead to underprescribing and poorly controlled pain. On the contrary, unnecessary overprescribing can increase the risk for misuse, abuse, and diversion. The primary objective of this study was to compare the demographics and clinical characteristics of children with an extremity fracture who did and did not receive an opioid prescription from a tertiary care children's hospital. METHODS This was a retrospective cohort study of children younger than 22 years with extremity fracture evaluated at a tertiary care children's hospital emergency department (ED) and surrounding satellite locations (3 EDs and 4 urgent cares), from January 1, 2017, to December 31, 2017. RESULTS There were 3325 patients younger than 22 years who were seen for evaluation of an extremity fracture. The overall median age of patients was 8 years (interquartile range [IQR], 4-11), and 1976 (59.4%) were male. Patients with extremity fractures who received opioid analgesics were older than those who did not receive opioids (median age of 10 years [IQR, 6-13 years] vs 7 years [IQR, 4-11 years], P < 0.001). There was a significant difference found between insurance types, specifically those patients receiving Medicaid and private insurance. Patients who received opioid analgesics had a higher initial pain score (7 [IQR, 4-9] vs 5 [IQR, 2-7], P < 0.001), were more likely to have an physician (MD/DO) provider (P < 0.001), and were more likely to present to the ED (P < 0.001). CONCLUSIONS Younger patients, patients with Medicaid insurance, patients treated by an advanced care provider, and patients who presented to an urgent care were less likely to receive opioid analgesics upon discharge. These findings demonstrate that more standardization and guidance on opioid prescribing are needed in pediatrics, to both adequately treat pain and reduce harms from overprescribing of opioid analgesics.
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Affiliation(s)
| | - Jennifer Reese
- Division of Hospitalist Medicine, University of Colorado Anschutz Medical Campus
| | | | - Jan Leonard
- Division of Emergency Medicine, University of Colorado Anschutz Medical Campus
| | - Tod Bos
- Department of Clinical Effectiveness, Children's Hospital Colorado
| | - Alan Bielsky
- Department of Anesthesia, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah Nickels
- Department of Clinical Effectiveness, Children's Hospital Colorado
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20
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Chua WJ, Klein EJ, Al-Haddad BJS, Quan L. Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:e1093-e1097. [PMID: 31436676 DOI: 10.1097/pec.0000000000001908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to describe the prescribing patterns of oxycodone for patients with distal upper extremity fractures and to evaluate factors that influence the quantity of oxycodone prescribed at discharge. METHODS We retrospectively studied oxycodone prescriptions for patients with upper extremity fractures presenting to a single center tertiary pediatric emergency department (ED) from June 1, 2014, to May 31, 2016. We used logistic regression models to evaluate the association of opioid administration in the ED, fracture reduction under ketamine sedation, initial pain scores (low, medium, and high), patient demographics, and type of prescriber (residents, attendings, fellows, and advanced registered nurse practitioners) with oxycodone prescription at discharge and the number of doses prescribed (≤12 or >12 doses). RESULTS A total of 1185 patients met the inclusion criteria. Of these, 669 (56%) were prescribed oxycodone at discharge. Children with fractures requiring reduction had 13 times higher odds [95% confidence interval (CI), 9.45-20.12] of receiving an oxycodone prescription compared with children with fractures not requiring reduction. Opioid administration in the ED was associated with 7.5 times higher odds (95% CI, 5.41-10.51) of receiving an outpatient prescription. Children were more likely to have a higher quantity of oxycodone prescribed if they had a fracture reduction in the ED [odds ratio (OR), 1.73; 95% CI, 1.20-2.50], received an opioid in the ED (OR, 2.13; 95% CI, 1.43-3.20), or received their prescription from an emergency medicine resident (OR, 2.8; 95% CI, 1.44-5.74). CONCLUSIONS Opioid prescribing differs based on patient- and provider-related factors. Given the variability in prescribing patterns, changing suggested opioid prescriptions in the electronic medical record may lead to more consistent practice and therefore decrease unnecessary prescribing while still ensuring adequate outpatient analgesia.
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21
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Lavingia R, Mondragon E, McFarlane-Johansson N, Shenoi RP. Improving Opioid Stewardship in Pediatric Emergency Medicine. Pediatrics 2021; 148:183393. [PMID: 34851415 DOI: 10.1542/peds.2020-039743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Poor opioid stewardship contributes to opioid misuse and adverse health outcomes. We sought to decrease opioid prescriptions in children 0 to 18 years treated for pain after fractures and cutaneous abscess drainage from 13.5% to 8%. Our secondary aims were to reduce opioid prescriptions written for >3 days from 41% to 10%, eliminate codeine prescriptions, increase safe opioid storage and disposal discharge instructions from 0% to 70%, and enroll all emergency department (ED) physicians in the state prescription drug monitoring program. METHODS We implemented an intervention bundle on the basis of 4 key drivers at a pediatric ED: ED-wide education, changes in the electronic medical record, discharge resources, and process standardization. Two plan-do-study-act cycles were performed. Interventions included provider feedback on prescribing, safe opioid storage and disposal instructions, and streamlined electronic medical record functions. Run charts were used to analyze the effect of interventions on outcomes. Our balance measure was return ED or clinic visits for inadequate analgesia within 3 days. RESULTS During the intervention period, 249 of 3402 (7.3%) patients with fractures and cutaneous abscesses were prescribed opioids. The percentage of opioid prescriptions >3 days decreased from 41% to 13.2% (P < .0001), codeine prescription dropped from 1.1% to 0% (P = .09), opioid discharge instructions increased 0% to 100% (P < .0001), and all physicians enrolled in the prescription drug monitoring program. There was no change in return visits for uncontrolled analgesia compared with the baseline (P = .79). CONCLUSIONS A comprehensive opioid stewardship program can improve opioid prescribing practices of ED physicians and deliver information on safe storage and disposal of prescription opioids with a negligible effect on return visits for uncontrolled pain.
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Affiliation(s)
| | | | - Nina McFarlane-Johansson
- Section of Emergency Medicine, Department of Pediatrics.,Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
| | - Rohit P Shenoi
- Section of Emergency Medicine, Department of Pediatrics.,Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
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Hamina A, Handal M, Fredheim O, Clausen T, Chen L, Skurtveit S. Filled prescriptions for opioids among children and adolescents - A nationwide study from 2010 to 2018. Acta Anaesthesiol Scand 2021; 65:1475-1483. [PMID: 34374072 DOI: 10.1111/aas.13968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prescribing opioids for children and adolescents should be reserved for advanced life-limiting diseases and moderate-to-severe acute pain. Pediatric codeine use is discouraged by several authorities, but the effects of these recommendations are not fully known. We investigated opioid utilization trends among 0-18-year-olds and characterized those who filled ≥1 opioid prescriptions, with emphasis on those who did so >3 times within a year. METHODS The prevalence of filled opioid prescriptions among 0-18-year-old Norwegians in 2010-2018 (N = 77,942) was measured from nationwide healthcare registries. Characteristics, healthcare utilization, and other drug use of those who newly filled 1, 2-3, or >3 opioid prescriptions in 2011-2014 were compared to 2015-2018, excluding persons with cancer. RESULTS From 2010 to 2018, the prevalence of opioid use decreased from 9.0 to 7.0 per 1000 persons. The largest decrease was among children <12 years, from 4.1 to 0.4 per 1000 persons, mainly due to decreasing codeine use. The proportion of those who filled >3 opioid prescriptions was 2.1% in 2011-2014 and 3.1% in 2015-2018. Those with >3 dispensations had a median of 4 contacts/year with secondary healthcare (interquartile range 2-7); the most frequent diagnoses indicated post-surgery follow-up. Most commonly dispensed other drugs were non-steroidal anti-inflammatory drugs. CONCLUSIONS Opioid dispensations for the young have declined in recent years. Multiple opioid dispensations were rare and associated with frequent healthcare utilization. Reducing codeine is in line with recommendations, but the effects of decreased opioid use on the quality of pain management remain unknown.
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Affiliation(s)
- Aleksi Hamina
- Norwegian Centre for Addiction Research (SERAF) Institute of Clinical Medicine University of Oslo Oslo Norway
- School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Marte Handal
- Department of Mental Disorders Division of Mental and Physical Health the Norwegian Institute of Public Health Oslo Norway
| | - Olav Fredheim
- Department of Circulation and Medical Imaging Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
- Norwegian Advisory Unit on Complex Symptom Disorders St. Olav University Hospital Trondheim Norway
- Department of Palliative Medicine Akershus University Hospital Lørenskog Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Li‐Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety Division of Pharmacy and Optometry School of Health Sciences Faculty of Biology, Medicine and Health University of ManchesterManchester Academic Health Science Centre Manchester UK
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research (SERAF) Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Mental Disorders Division of Mental and Physical Health the Norwegian Institute of Public Health Oslo Norway
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Goyal MK, Drendel AL, Chamberlain JM, Wheeler J, Olsen C, Grundmeier RW, Cook L, Bajaj L, Babcock L, Zorc JJ, Johnson T, Alpern ER. Racial/Ethnic Differences in ED Opioid Prescriptions for Long Bone Fractures: Trends Over Time. Pediatrics 2021; 148:peds.2021-052481. [PMID: 34645690 DOI: 10.1542/peds.2021-052481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Monika K Goyal
- Department of Pediatric Emergency Medicine, Children's National Hospital and The School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Amy L Drendel
- Department of Pediatrics, Medical College of Wisconsin, University of Wisconsin, Madison, Wisconsin
| | - James M Chamberlain
- Department of Pediatric Emergency Medicine, Children's National Hospital and The School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Justin Wheeler
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Cody Olsen
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Robert W Grundmeier
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Larry Cook
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Lalit Bajaj
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Lynn Babcock
- Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center
| | - Joeseph J Zorc
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffani Johnson
- Department of Emergency Medicine, University of California Davis, Sacramento, California
| | - Elizabeth R Alpern
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital
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Renny MH, Yin HS, Jent V, Hadland SE, Cerdá M. Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA Pediatr 2021; 175:1043-1052. [PMID: 34180978 PMCID: PMC8240008 DOI: 10.1001/jamapediatrics.2021.1832] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Prescription opioids are involved in more than half of opioid overdoses among younger persons. Understanding opioid prescribing practices is essential for developing appropriate interventions for this population. OBJECTIVE To examine temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018. DESIGN, SETTING, AND PARTICIPANTS A population-based, cross-sectional analysis of opioid prescription data was conducted from January 1, 2006, to December 31, 2018. Longitudinal data on retail pharmacy-dispensed opioids for patients younger than 25 years were used in the analysis. Data analysis was performed from December 26, 2019, to July 8, 2020. MAIN OUTCOMES AND MEASURES Opioid dispensing rate, mean amount of opioid dispensed in morphine milligram equivalents (MME) per day (individuals aged 15-24 years) or MME per kilogram per day (age <15 years), duration of prescription (mean, short [≤3 days], and long [≥30 days] duration), high-dosage prescriptions, and extended-release or long-acting (ER/LA) formulation prescriptions. Outcomes were calculated for age groups: 0 to 5, 6 to 9, 10 to 14, 15 to 19, and 20 to 24 years. Joinpoint regression was used to examine opioid prescribing trends. RESULTS From 2006 to 2018, the opioid dispensing rate for patients younger than 25 years decreased from 14.28 to 6.45, with an annual decrease of 15.15% (95% CI, -17.26% to -12.99%) from 2013 to 2018. The mean amount of opioids dispensed and rates of short-duration and high-dosage prescriptions decreased for all age groups older than 5 years, with the largest decreases in individuals aged 15 to 24 years. Mean duration per prescription increased initially for all ages, but then decreased for individuals aged 10 years or older. The duration remained longer than 5 days across all ages. The rate of long-duration prescriptions increased for all age groups younger than 15 years and initially increased, but then decreased after 2014 for individuals aged 15 to 24 years. For children aged 0 to 5 years dispensed an opioid, annual increases from 2011 to 2014 were noted for the mean amount of opioids dispensed (annual percent change [APC], 10.58%; 95% CI, 1.77% to 20.16%) and rates of long-duration (APC, 30.42%; 95% CI, 14.13% to 49.03%), high-dosage (APC, 31.27%; 95% CI, 16.81% to 47.53%), and ER/LA formulation (APC, 27.86%; 95% CI, 12.04% to 45.91%) prescriptions, although the mean amount dispensed and rate of high-dosage prescriptions decreased from 2014 to 2018. CONCLUSIONS AND RELEVANCE These findings suggest that opioid dispensing rates decreased for patients younger than 25 years, with decreasing rates of high-dosage and long-duration prescriptions for adolescents and younger adults. However, opioids remain readily dispensed, and possible high-risk prescribing practices appear to be common, especially in younger children.
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Affiliation(s)
- Madeline H. Renny
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York,Department of Population Health, New York University Grossman School of Medicine, New York,Department of Emergency Medicine, New York University Grossman School of Medicine, New York,Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - H. Shonna Yin
- Department of Population Health, New York University Grossman School of Medicine, New York,Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Victoria Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Scott E. Hadland
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York
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Anderson JL, Oliveira J E Silva L, Funni SA, Bellolio F, Jeffery MM. Epidemiology of paediatric pain-related visits to emergency departments in the USA: a cross-sectional study. BMJ Open 2021; 11:e046497. [PMID: 34400448 PMCID: PMC8370556 DOI: 10.1136/bmjopen-2020-046497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of paediatric pain-related visits to emergency departments (EDs) across the USA. DESIGN Cross-sectional study. SETTING A representative sample of US ED visits using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). PARTICIPANTS Paediatric (age ≤18 years) ED visits in the 2017 NHAMCS data set. DATA ANALYSIS Each visit was coded as pain-related or non-pain-related using the 'reason for visit' variable. Weighted proportions were calculated with 95% CIs. Logistic regression was used to compare odds of pain-related visits. OUTCOME MEASURES Prevalence of pain-related visits among paediatric ED visits. RESULTS There were an estimated 35 million paediatric ED visits in the USA in 2017, 55.6% (CI 53.3% to 57.8%) were pain related, which equates to 19.7 million annual visits. The prevalence of pain-related visits reached more than 50% of visits at age 6-7 and plateaued at relatively high proportions. Children of races other than white or black had lower odds of having a pain-related visit (OR 0.48, CI 0.29 to 0.81) than white children, as did children who were black, though the difference was not statistically significant (OR 0.88, CI 0.73 to 1.06). Relative to children covered by private insurance, children with Medicaid or CHIP (Children's Health Insurance Program) coverage had lower odds of a pain-related visit (OR 0.75, CI 0.60 to 0.93). Injuries represented 46.5% (CI 42.0% to 51.0%) of pain-related visits. Pain scores were reported in less than 50% of pain-related visits. CONCLUSION Pain is the reason for visit in 55.6% of paediatric ED visits across the USA. The prevalence of pain-related visits peak before adolescence and it continues relatively high until the age 18. Injury, racial disparities in pain and poor pain score reporting should remain major topics of study in the paediatric population.
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Affiliation(s)
- Jana L Anderson
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shealeigh A Funni
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Molly Moore Jeffery
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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26
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Racial and ethnic disparities in opioid use for adolescents at US emergency departments. BMC Pediatr 2021; 21:252. [PMID: 34059005 PMCID: PMC8165785 DOI: 10.1186/s12887-021-02715-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. Methods This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11–21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method. Results There was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6–15.9%), and 17.4% (95% CI, 16.5–18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601–0.906, aOR = 0.739, 95% CI 0.578–0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500–0.672, aOR = 0.807, 95% CI 0.685–0.951, respectively) compared to non-Hispanic Whites. Conclusions Differences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02715-y.
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Ward A, Jani T, De Souza E, Scheinker D, Bambos N, Anderson TA. Prediction of Prolonged Opioid Use After Surgery in Adolescents: Insights From Machine Learning. Anesth Analg 2021; 133:304-313. [PMID: 33939656 DOI: 10.1213/ane.0000000000005527] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Long-term opioid use has negative health care consequences. Patients who undergo surgery are at risk for prolonged opioid use after surgery (POUS). While risk factors have been previously identified, no methods currently exist to determine higher-risk patients. We assessed the ability of a variety of machine-learning algorithms to predict adolescents at risk of POUS and to identify factors associated with this risk. METHODS A retrospective cohort study was conducted using a national insurance claims database of adolescents aged 12-21 years who underwent 1 of 1297 surgeries, with general anesthesia, from January 1, 2011 to December 30, 2017. Logistic regression with an L2 penalty and with a logistic regression with an L1 lasso (Lasso) penalty, random forests, gradient boosting machines, and extreme gradient boosted models were trained using patient and provider characteristics to predict POUS (≥1 opioid prescription fill within 90-180 days after surgery) risk. Predictive capabilities were assessed using the area under the receiver-operating characteristic curve (AUC)/C-statistic, mean average precision (MAP); individual decision thresholds were compared using sensitivity, specificity, Youden Index, F1 score, and number needed to evaluate. The variables most strongly associated with POUS risk were identified using permutation importance. RESULTS Of 186,493 eligible patient surgical visits, 8410 (4.51%) had POUS. The top-performing algorithm achieved an overall AUC of 0.711 (95% confidence interval [CI], 0.699-0.723) and significantly higher AUCs for certain surgeries (eg, 0.823 for spinal fusion surgery and 0.812 for dental surgery). The variables with the strongest association with POUS were the days' supply of opioids and oral morphine milligram equivalents of opioids in the year before surgery. CONCLUSIONS Machine-learning models to predict POUS risk among adolescents show modest to strong results for different surgeries and reveal variables associated with higher risk. These results may inform health care system-specific identification of patients at higher risk for POUS and drive development of preventative measures.
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Affiliation(s)
- Andrew Ward
- From the Department of Electrical Engineering, Stanford University, Stanford, California
| | - Trisha Jani
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California
| | - Elizabeth De Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, California
| | - Nicholas Bambos
- From the Department of Electrical Engineering, Stanford University, Stanford, California.,Department of Management Science and Engineering, Stanford University, Stanford, California
| | - T Anthony Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Bryl AW, Demartinis N, Etkin M, Hollenbach KA, Huang J, Shah S. Reducing Opioid Doses Prescribed From a Pediatric Emergency Department. Pediatrics 2021; 147:peds.2020-1180. [PMID: 33674462 DOI: 10.1542/peds.2020-1180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Opioid overdose and abuse have reached epidemic rates in the United States. Medical prescriptions are a large source of opioid misuse. Our quality improvement initiative aimed to reduce opioid exposure from the pediatric emergency department (ED). Objective was to reduce opioid doses prescribed weekly from our ED by 50% within 4 months. METHODS Three categories of interventions were implemented in Plan-Do-Study-Act cycles: guidelines and education, electronic medical record optimization, and provider-specific feedback. Primary measures were opioid doses prescribed weekly from the ED and opioid doses per 100 ED visits. Process measures were opioid prescriptions, opioid doses per prescription, and opioid prescriptions for unspecified abdominal pain, headache, and viral upper respiratory infection. Balancing measures were phone calls and return visits for poor pain control in patients prescribed opioids and reports of poor pain control in call backs to orthopedic reduction patients. We used statistical process control to examine changes in measures over time. RESULTS Opioid doses decreased from 153 to 14 per week and from 8 to 0.7 doses per 100 ED visits in 10 months, sustained for 9 months. Opioid prescriptions, opioid doses per prescription, and prescriptions for unspecified abdominal pain, headache, and viral upper respiratory infection decreased. Phone calls and return visits in patients prescribed opioids did not increase. There were 2 reports of poor pain control among 152 orthopedic reduction patients called back. CONCLUSIONS We decreased opioid doses prescribed weekly from the pediatric ED by 91% while minimizing return visits and reports of poor pain control.
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Affiliation(s)
- Amy W Bryl
- Department of Pediatrics, School of Medicine and .,Emergency Care Center, Rady Children's Hospital San Diego, San Diego, California
| | - Nicole Demartinis
- Department of Pediatrics, School of Medicine and.,Emergency Care Center, Rady Children's Hospital San Diego, San Diego, California
| | - Marc Etkin
- Department of Pediatrics, School of Medicine and.,Emergency Care Center, Rady Children's Hospital San Diego, San Diego, California
| | - Kathryn A Hollenbach
- Emergency Care Center, Rady Children's Hospital San Diego, San Diego, California.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California; and
| | | | - Seema Shah
- Department of Pediatrics, School of Medicine and.,Emergency Care Center, Rady Children's Hospital San Diego, San Diego, California
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29
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Wilson JD, Abebe KZ, Kraemer K, Liebschutz J, Merlin J, Miller E, Kelley D, Donohue J. Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults. JAMA Netw Open 2021; 4:e214552. [PMID: 33885777 PMCID: PMC8063062 DOI: 10.1001/jamanetworkopen.2021.4552] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks. OBJECTIVE To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020. MAIN OUTCOMES AND MEASURES This study used group-based trajectory modeling and defined trajectory status by opioid fill. RESULTS Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001). CONCLUSIONS AND RELEVANCE This study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.
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Affiliation(s)
- J. Deanna Wilson
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin Kraemer
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jane Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Merlin
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Kelley
- Pennsylvania Office of Medical Assistance Programs, Harrisburg
| | - Julie Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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30
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Phan MT, Wong C, Tomaszewski DM, Kain ZN, Jenkins B, Donaldson C, Fortier M, Yang S. Evaluating Opioid Dispensing Rates among Pediatrics and Young Adults based on CURES Data Reporting in California from 2015-2019. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2021; 67:23-32. [PMID: 34368640 DOI: 10.37901/jcphp20-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Receipt of opioid prescriptions in pediatric and young adult patients may be a risk factor for future opioid misuse. Data from prescription drug monitoring programs provide insight on outpatient opioid use. In our study, we analyzed the opioid dispensing rates for pediatrics and young adults in California. Methods A secondary analysis was performed from 2015-2019 using Controlled Utilization Review and Evaluation System data. This database provides dispensing data of controlled substances in California. Patients younger than 25 years who were prescribed opiates were analyzed by county. We further divided them into two groups (children: ≤14 years; adolescents and young adult: 15-24 years). Descriptive statistics and heat maps were used to illustrate the trends in opioid usage among different age groups. Results The overall percentages for the number of opioids being dispensed to patients aged <25 years have decreased over the past four years. In 2015, 6 out of 58 counties in California were considered "high-rate" with >2.9% of opioids dispensed to patients younger than 25 years old; in 2019, this number reduced to zero. Patients 25 and older received a higher proportion of opioids compared to younger populations; in 2019, 35.91% of opioids were dispensed to patients 45-64, and 8.92% to patients younger than 25. Conclusion Pediatric opioid prescriptions have declined over the recent years. However, a high degree of variability of prescription rates between demographic counties was noted. More studies are warranted in order to understand this discrepancy in opioid prescribing among pediatric and young adult patients.
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Affiliation(s)
| | | | - Daniel M Tomaszewski
- Department of Pharmaceutical and Health Economics at the University of Southern California's School of Pharmacy
| | - Zeev N Kain
- Department of Anesthesiology & Perioperative Care at the University of California, Irvine School of Medicine
| | - Brooke Jenkins
- Crean College of Health and Behavioral Sciences at Chapman University
| | - Candice Donaldson
- Crean College of Health and Behavioral Sciences at Chapman University
| | - Michelle Fortier
- Sue & Bill Gross School of Nursing, UCI Center on Stress & Health, Department of Anesthesiology & Perioperative Care, and Department of Pediatric Psychology, CHOC Children's
| | - Sun Yang
- Chapman University School of Pharmacy
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31
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Basco WT, McCauley JL, Zhang J, Mauldin PD, Simpson KN, Heidari K, Marsden JE, Ball SJ. Trends in Dispensed Opioid Analgesic Prescriptions to Children in South Carolina: 2010-2017. Pediatrics 2021; 147:e20200649. [PMID: 33526605 PMCID: PMC7924141 DOI: 10.1542/peds.2020-0649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite published declines in opioid prescribing and dispensing to children in the past decade, in few studies have researchers evaluated all children in 1 state or examined changes in mean daily opioid dispensed. In this study, we evaluated changes in the rate of dispensed opioid analgesics and the mean daily opioid dispensed to persons 0 to 18 years old in 1 state over an 8-year period. METHODS We identified opioid analgesics dispensed to children 0 to 18 years old between 2010 and 2017 using South Carolina prescription drug monitoring program data. We used generalized linear regression analyses to examine changes over time in the following: (1) rate of dispensed opioid prescriptions and (2) mean daily morphine milligram equivalents (MMEs) per prescription. RESULTS From the first quarter of 2010 to the end of the fourth quarter of 2017, the quarterly rate of opioids dispensed decreased from 18.68 prescriptions per 1000 state residents to 12.03 per 1000 residents (P < .0001). The largest declines were among the oldest individuals, such as the 41.2% decline among 18-year-olds. From 2010 through 2017, the mean daily MME dispensed declined by 7.6%, from 40.7 MMEs per day in 2010 to 37.6 MMEs per day in 2017 (P < .0001), but the decrease was limited to children 0 to 9 years old. CONCLUSIONS The rate of opioid analgesic prescriptions dispensed to children 0 to 18 years old in South Carolina declined by 35.6% over the years 2010-2017; however, the MME dispensed per day declined minimally, suggesting that more can be done to improve opioid prescribing and dispensing.
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Affiliation(s)
| | | | | | | | - Kit N Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; and
| | - Khosrow Heidari
- BlueCross BlueShield of South Carolina, Columbia, South Carolina
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Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting. J Clin Psychol Med Settings 2021; 28:757-770. [PMID: 33564959 DOI: 10.1007/s10880-021-09763-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 12/18/2022]
Abstract
This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.
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Griesler PC, Hu MC, Wall MM, Kandel DB. Assessment of Prescription Opioid Medical Use and Misuse Among Parents and Their Adolescent Offspring in the US. JAMA Netw Open 2021; 4:e2031073. [PMID: 33410876 PMCID: PMC7791357 DOI: 10.1001/jamanetworkopen.2020.31073] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Limited information is available regarding the association between parental and adolescent medical prescription opioid use and misuse in the US. Objective To examine the associations between parental and adolescent prescription opioid medical use and misuse. Design, Setting, and Participants This cross-sectional, nationally representative study included 15 200 parent-adolescent dyads from the annual 2015-2017 National Survey on Drug Use and Health. Data were collected from January 6, 2015, to December 20, 2017, and analyzed from October 4, 2019, to October 15, 2020. Exposures Parental past 12-month exclusive medical prescription opioid use and any misuse (ie, using without a prescription or in any way not directed by a physician). Main Outcomes and Measures Adolescent past 12-month medical prescription opioid use or misuse. Multivariable regressions estimated associations between parental and offspring medical prescription opioid use or misuse, controlling for sociodemographic and psychosocial variables. Results Respondents included 9400 mother-child and 5800 father-child dyads in the same household; children were aged 12 to 17 years (52.8% male; mean [SD] age, 14.5 [1.7] years). Controlling for other factors, parental medical prescription opioid use was associated with adolescent prescription opioid medical use (adjusted odds ratio [aOR], 1.28; 95% CI, 1.06-1.53) and misuse (aOR, 1.53; 95% CI, 1.07-2.25), whereas parental misuse was not. Parental medical prescription stimulant use was associated with adolescent medical prescription opioid use (aOR, 1.40; 95% CI, 1.02-1.91). Parental marijuana use (aOR, 1.84; 95% CI, 1.13-2.99), parent-adolescent conflict (aOR, 1.26; 95% CI, 1.05-1.52), and adolescent depression (aOR, 1.75; 95% CI, 1.26-2.44) were associated with adolescent prescription opioid misuse. Adolescent delinquency (aOR, 1.55; 95% CI, 1.38-1.74) and perceived schoolmates' drug use (aOR, 2.87; 95% CI, 1.95-4.23) were also associated with adolescent misuse and more weakly with medical use (aORs, 1.13 [95% CI, 1.05-1.22] and 1.61 [95% CI, 1.32-1.96], respectively). Conclusions and Relevance Youth use of prescription opioids is in part a structural/environmental issue. The findings of this study suggest that parental medical prescription opioid use is associated with offspring prescription opioid use, whereas parental misuse is not. Restricting physicians' opioid prescribing to parents is a crucial public health goal. In addition, parents could be educated on the risks of their prescription opioid use for offspring and on practices to mitigate risk, including safe medication storage and disposal. Screening for parental prescription opioid use could be part of pediatric practice. Addressing adolescent mental health could also reduce adolescent prescription opioid misuse.
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Affiliation(s)
- Pamela C. Griesler
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
- Research Foundation for Mental Hygiene, New York, New York
| | - Denise B. Kandel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
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Wang PR, Lopez R, Seballos SS, Campbell MJ, Udeh BL, Phelan MP. Management of migraine in the emergency department: Findings from the 2010-2017 National Hospital Ambulatory Medical Care Surveys. Am J Emerg Med 2021; 41:40-45. [PMID: 33385884 DOI: 10.1016/j.ajem.2020.12.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The study objective was to describe trends in the medical management of migraine in the emergency department (ED) using the 2010-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) datasets. METHODS Using the 2010-2017 NHAMCS datasets, we analyzed visits with a discharge diagnosis of migraine. Drug prescription frequencies between years were compared with the Rao-Scott chi-squared test. Adjusted odds ratios of opioid administration from 2010 to 2017 were calculated using weighted multivariable logistic regression with sex, age, race/ethnicity, pain-score, primary expected source of payment, and year as predictor variables. RESULTS Our analysis captured 1846 ED visits with a diagnosis of migraine from 2010 to 2017, representing a weighted average of 1.2 million US ED visits per year. Parenteral opioids were prescribed in 49% (95% CI: 40, 58) of visits in 2010 and 28% (95% CI: 15, 45) of visits in 2017 (p = 0.03). From 2010 to 2017, there was a 10% yearly decrease in opioid prescriptions. Metoclopramide and ketorolac were prescribed more frequently in years 2015 through 2017 than in 2010. Increased opioid administration was associated with female sex, older age, white race, higher pain score, and having Medicare or private insurance as the primary expected source of payment for all years. CONCLUSION Opioid administration for migraine in EDs across the US declined 10% annually between 2010 and 2017, demonstrating improved adherence to migraine guidelines recommending against opioids. We identified several factors associated with opioid administration for migraine, identifying groups at higher risk for unnecessary opioids in the ED setting.
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Affiliation(s)
- Philip R Wang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America.
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
| | - Spencer S Seballos
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America
| | - Matthew J Campbell
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States of America
| | - Belinda L Udeh
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America; Neurological Institute Center for Outcomes Research, Cleveland Clinic, Cleveland, OH, United States of America
| | - Michael P Phelan
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, United States of America
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Guedj R, Marini M, Kossowsky J, Berde CB, Kimia AA, Fleegler EW. Racial and Ethnic Disparities in Pain Management of Children With Limb Fractures or Suspected Appendicitis: A Retrospective Cross-Sectional Study. Front Pediatr 2021; 9:652854. [PMID: 34414139 PMCID: PMC8369476 DOI: 10.3389/fped.2021.652854] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate whether racial/ethnical differences in analgesia administration existed in two different cohorts of children with painful conditions: children with either limb fracture or suspected appendicitis. Methods: Retrospective cross-sectional analysis of children visiting a pediatric emergency department (Boston Children Hospital) for limb fracture or suspected appendicitis from 2011 to 2015. We computed the proportion of children that received any analgesic treatment and any opioid analgesia. We performed multivariable logistic regressions to investigate race/ethnicity differences in analgesic and opioid administration, after adjusting for pain score, demographics and visit covariates. Results: Among the 8,347 children with a limb fracture and the 4,780 with suspected appendicitis, 65.0 and 60.9% received any analgesic treatment, and 35.9 and 33.4% an opioid analgesia, respectively. Compared to White non-Hispanic Children, Black non-Hispanic children and Hispanic children were less likely to receive opioid analgesia in both the limb fracture cohort [Black: aOR = 0.61 (95% CI, 0.50-0.75); Hispanic aOR = 0.66 (95% CI, 0.55-0.80)] and in the suspected appendicitis cohort [Black: aOR = 0.75 (95% CI, 0.58-0.96); Hispanic aOR = 0.78 (95% CI, 0.63-0.96)]. In the limb fracture cohort, Black non-Hispanic children and Hispanic children were more likely to receive any analgesic treatment (non-opioid or opioid) than White non-Hispanic children [Black: aOR = 1.63 (95% CI, 1.33-2.01); Hispanic aOR = 1.43 (95% CI, 1.19-1.72)]. Conclusion: Racial and ethnic disparities exist in the pain management of two different painful conditions, which suggests true inequities in health care delivery. To provide equitable analgesic care, emergency departments should monitor variation in analgesic management and develop appropriate universal interventions.
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Affiliation(s)
- Romain Guedj
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatric Emergency Medicine, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, Paris, France.,Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, Paris, France
| | - Maddalena Marini
- Istituto Italiano di Tecnologia, Center for Translational Neurophysiology, Ferrara, Italy
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Amir A Kimia
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States
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Evaluation of racial disparities in postoperative opioid prescription filling after common pediatric surgical procedures. J Pediatr Surg 2020; 55:2575-2583. [PMID: 32829884 DOI: 10.1016/j.jpedsurg.2020.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Racially disparate pain management affects both adult and pediatric patients, but is not well studied among pediatric surgical patients after discharge. The objectives were to evaluate racial disparities in pediatric postoperative opioid prescription filling. METHODS This retrospective cohort study included black or white pediatric Medicaid patients who underwent tonsillectomy, supracondylar humeral fracture fixation, or appendectomy (2/2012-7/2016). Patients were followed for 14 days post-surgery to identify opioid prescription fills. Logistic regression models evaluated the association between race and the probability of filling an opioid prescription. RESULTS Among 39,316 surgical patients, the proportions of patients with post-surgical opioid prescriptions were 66.0%, 83.9%, and 68.5%, among tonsillectomy, supracondylar fracture, and appendectomy patients, respectively. The proportion of black appendectomy patients with a postoperative opioid prescription was significantly lower compared to white patients (65.0% vs. 69.2% respectively, p = 0.03), but was no longer significant after adjusting for other patient and provider characteristics. There were no differences by race in opioid prescription filling among other surgical patient groups. CONCLUSIONS The present study did not identify racial disparities in opioid prescription filling in adjusted analyses. Racial differences in unadjusted postoperative opioid prescription filling among appendectomy patients may be explained in part by longer postoperative length-of-stay among black children. TYPE OF STUDY Prognosis Study LEVEL OF EVIDENCE: Level II.
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Donaldson CD, Jenkins BN, Fortier MA, Phan MT, Tomaszewski DM, Yang S, Kain ZN. Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption. J Psychosom Res 2020; 138:110251. [PMID: 32979697 PMCID: PMC8552765 DOI: 10.1016/j.jpsychores.2020.110251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/25/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain. METHODS Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy surgery and their parents. Longitudinal multilevel modeling examined changes in both parent-reported pain and hydrocodone/APAP consumption (mg/kg) on days 1 to 7 after surgery. RESULTS Parent reports of postoperative pain were higher in Hispanic/Latinx patients compared to their Non-Hispanic White counterparts (β = -0.15; 95% CI: -0.28, -0.01). There was also a significant interaction of ethnicity and pain on opioid consumption (β = 0.07; 95% CI: 0.01, 0.13). The relationship between parent perceived pain and opioid use was stronger for Non-Hispanic White children, suggesting that this group was more likely to consume opioids to help manage clinically significant postsurgical pain. CONCLUSIONS Hispanic/Latinx children might be at risk for undertreatment of surgical pain. Findings highlight the importance of assessing parent background and cultural beliefs as predictors of at home pain management and the potential effectiveness of tailored interventions that educate parents about monitoring and treating child postoperative pain.
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Affiliation(s)
- Candice D. Donaldson
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America
| | - Brooke N. Jenkins
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America
| | - Michelle A. Fortier
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Sue & Bill Gross School of Nursing, United States of America
| | - Michael T. Phan
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America
| | - Daniel M. Tomaszewski
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America,University of Southern California, School of Pharmacy, Schaeffer Center for Health Policy and Economics, United States of America
| | - Sun Yang
- Chapman University, School of Pharmacy, Department of Pharmacy Practice, United States of America
| | - Zeev N. Kain
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America,Corresponding author at: UCI Center on Stress & Health, 505 S. Main Street, Suite 940, Orange, CA 92868, United States of America. (Z.N. Kain)
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Abstract
: Level of Evidence: 3.
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Brown KW, Carlisle K, Raman SR, Shrader P, Jiao M, Smith MJ, Einhorn LM, Wong CA. Children And The Opioid Epidemic: Age-Stratified Exposures And Harms. Health Aff (Millwood) 2020; 39:1737-1742. [PMID: 33017234 DOI: 10.1377/hlthaff.2020.00724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using North Carolina Medicaid 2016-18 claims data, we found that approximately one in ten adolescents (10.8 percent) filled at least one opioid prescription per year. Dentists, advanced practice providers, and surgeons were common prescribers of opioids to children. In addition, half of children who experienced opioid-related adverse events had filled opioid prescriptions in the prior six months.
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Affiliation(s)
- Kelby W Brown
- Kelby W. Brown is a graduate scholar in the Duke-Margolis Center for Health Policy at Duke University, in Durham, North Carolina
| | - Kayla Carlisle
- Kayla Carlisle is a student scholar in the Children's Health and Discovery Initiative at Duke University
| | - Sudha R Raman
- Sudha R. Raman is an assistant professor of population health sciences at Duke University School of Medicine
| | - Peter Shrader
- Peter Shrader is a biostatistician in Outcomes at the Duke Clinical Research Institute
| | - Megan Jiao
- Megan Jiao is a research associate in the Duke-Margolis Center for Health Policy at Duke University
| | - Michael J Smith
- Michael J. Smith is an associate professor of pediatrics at Duke University School of Medicine
| | - Lisa M Einhorn
- Lisa M. Einhorn is an assistant professor of anesthesiology at Duke University School of Medicine
| | - Charlene A Wong
- Charlene A. Wong is an associate professor of pediatrics and public policy at Duke University, the Children's Health and Discovery Initiative, and the Duke-Margolis Center for Health Policy
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Ehwerhemuepha L, Donaldson CD, Kain ZN, Luong V, Fortier MA, Feaster W, Weiss M, Tomaszewski D, Yang S, Phan M, Jenkins BN. Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting. J Racial Ethn Health Disparities 2020; 8:1232-1241. [PMID: 33000430 DOI: 10.1007/s40615-020-00882-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. METHODS Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. RESULTS There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. CONCLUSION Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.
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Affiliation(s)
- Louis Ehwerhemuepha
- Department of Information Systems, Children's Hospital of Orange County, CA, 92868, Orange, USA
| | - Candice D Donaldson
- Department of Psychology, Chapman University, Orange, CA, 92866, USA
- Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, 92697, USA
- Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Vivian Luong
- Department of Psychology, Chapman University, Orange, CA, 92866, USA
- Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA
| | - Michelle A Fortier
- Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA
- Children's Hospital of Orange County, Orange, CA, 92868, USA
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, 92697, USA
| | - William Feaster
- Department of Information Systems, Children's Hospital of Orange County, CA, 92868, Orange, USA
| | - Michael Weiss
- Population Health, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Daniel Tomaszewski
- School of Pharmacy Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, USA
| | - Sun Yang
- School of Pharmacy, Department of Pharmacy Practice, Chapman University, Orange, CA, 92868, USA
| | - Michael Phan
- School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, Chapman University, Orange, CA, 92868, USA
| | - Brooke N Jenkins
- Department of Psychology, Chapman University, Orange, CA, 92866, USA.
- Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA.
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, 92697, USA.
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Huang JF, Meng Z, Zheng XQ, Qin Z, Sun XL, Zhang K, Tian HJ, Wang XB, Gao Z, Li YM, Wu AM. Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain. Pain Ther 2020; 9:637-655. [PMID: 32940899 PMCID: PMC7648792 DOI: 10.1007/s40122-020-00193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Neck pain is a common condition that leads to serious pain, disability, and increased healthcare costs worldwide. Pharmacotherapy is one of the most common strategies to reduce neck pain in patients. The aim of this study was to analyze the real-world pattern of drugs prescribed for patients with neck pain in the USA. Methods Data on individuals who reported current neck pain in the 2009−2010 US National Health and Nutrition Examination Survey (NHANES) and with a history of persistent pain for at least 6 weeks or 3 months were extracted from the NHANES database. Those included in the study were divided into three groups based on the duration of pain: the without neck pain group (Group A); subacute group (Group B) with a history of 6 weeks of neck pain; and the chronic neck pain group (Group C) with a history of 3 months of neck pain. The use and duration of medication prescribed for Group A, B, and C patients were compared. Results The analysis revealed that opioid use was significantly more prevalent in the subacute and chronic neck pain group than in the without neck pain group (Group A) (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 2.07–8.52 and aOR 7.00, 95% CI 4.32–11.33, respectively). The factors strongly associated with higher opioid use included older age, low education level, and low family income. In the chronic neck group, opioids, followed in decreasing order of frequency by acetaminophen and nonsteroidal anti-infammatory drugs, were the most common analgesics used in combination with other analgesics. Conclusion Our analysis of the data shows that the long-term excessive use of opioids and the underutilization of other analgesics are two major issues in the treatment of neck pain in the USA. Possible improvements include improved education of patients by healthcare professionals on the use of opioids and more consideration given to non-pharmacotherapy options. Our results reveal the potential problem in pharmacotherapy choices for neck pain treatment and may help improve the current clinical practice in the USA and other countries.
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Affiliation(s)
- Jin-Feng Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Zhou Meng
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, 21201, USA
| | - Xuan-Qi Zheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Zongshi Qin
- Li Ka Shing Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, 300210, People's Republic of China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hai-Jun Tian
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiao-Bing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ze Gao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yan Michael Li
- Department of Neurosurgery and Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Ai-Min Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China.
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Phang KG, Roberts JR, Ebeling M, Garner SS, Basco WT. Opioids or Steroids for Pneumonia or Sinusitis. Pediatrics 2020; 146:peds.2019-3690. [PMID: 32616629 PMCID: PMC7397734 DOI: 10.1542/peds.2019-3690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care. METHODS We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting. RESULTS Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; P ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; P ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites. CONCLUSIONS School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.
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Affiliation(s)
| | - James R. Roberts
- Medical University of South Carolina, Charleston, South Carolina
| | - Myla Ebeling
- Medical University of South Carolina, Charleston, South Carolina
| | - Sandra S. Garner
- Medical University of South Carolina, Charleston, South Carolina
| | - William T. Basco
- Medical University of South Carolina, Charleston, South Carolina
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Masonbrink A, Richardson T, Catley D, Miller MK, Hall M, Kyler KE, Daly A, Synhorst D, Connelly M. Opioid Use to Treat Migraine Headaches in Hospitalized Children and Adolescents. Hosp Pediatr 2020; 10:401-407. [PMID: 32295812 DOI: 10.1542/hpeds.2020-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Prescription of opioids to treat pediatric migraine is explicitly discouraged by treatment guidelines but persists in some clinical settings. We sought to describe rates of opioid administration in pediatric migraine hospitalizations. METHODS Using data from the Pediatric Health Information System, we performed a cross-sectional study to investigate the prevalence and predictors of opioid administration for children aged 7 to 21 years who were hospitalized for migraine between January 1, 2016, and December 31, 2018. RESULTS There were 6632 pediatric migraine hospitalizations at 50 hospitals during the study period, of which 448 (7%) had an opioid administered during the hospitalization. There were higher adjusted odds of opioid administration in hospitalizations for non-Hispanic black (adjusted odds ratio [aOR], 1.68; P < .001) and Hispanic (aOR, 1.54; P = .005) (reference white) race and ethnicity, among older age groups (18-21 years: aOR, 2.74; P < .001; reference, 7-10 years), and among patients with higher illness severity (aOR, 2.58; P < .001). Hospitalizations during which an opioid was administered had a longer length of stay (adjusted rate ratio, 1.48; P < .001) and higher 30-day readmission rate (aOR, 1.96; P < .001). By pediatric hospital, opioid administration ranged from 0% to 23.5% of migraine hospitalizations. Hospitals with higher opioid administration rates demonstrated higher adjusted readmission rates (P < .001) and higher adjusted rates of return emergency department visits (P = .026). CONCLUSIONS Opioids continue to be used during pediatric migraine hospitalizations and are associated with longer lengths of stay and readmissions. These findings reveal important opportunities to improve adherence to migraine treatment guidelines and minimize unnecessary opioid exposure, with the potential to improve hospital discharge outcomes.
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Affiliation(s)
- Abbey Masonbrink
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Troy Richardson
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and.,Children's Hospital Association, Lenexa, Kansas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and.,Children's Hospital Association, Lenexa, Kansas
| | - Kathryn E Kyler
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Ashley Daly
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - David Synhorst
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Mark Connelly
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
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Foster AA, Porter JJ, Bourgeois FT, Mannix R. The use of opioids in low acuity pediatric trauma patients. PLoS One 2019; 14:e0226433. [PMID: 31841556 PMCID: PMC6913969 DOI: 10.1371/journal.pone.0226433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/26/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe temporal trends and factors associated with opioid administration among children discharged from the emergency department (ED) after a trauma visit. METHODS This was a cross-sectional study of ED visits for children <19 years old who received a trauma-related diagnosis and were discharged from the ED. Data were obtained from the National Hospital Ambulatory Medical Care Survey 2006-2015. OUTCOME MEASURES Administration of an opioid medication either during the ED visit or as a discharge prescription. Survey-adjusted regression analyses were used to determine the probability of a patient receiving an opioid medication. RESULTS During the study period, there were 19,241 pediatric trauma visits discharged from the ED, of which 14% were associated with an opioid. Opioid administration decreased by nearly 30% during the study period (p<0.001 for trend). In multivariable analysis, patient factors associated with opioid administration were adolescent age, evening visit, region of the country, and severe pain score. The diagnosis associated with the most opioids was ankle sprain and the diagnosis with the highest rate of opioid administration was radius fracture. The most common opioid administered to children under 12 years of age was acetaminophen-codeine. CONCLUSIONS Opioid administration appears to be decreasing among pediatric patients presenting to the ED with trauma, but a high number of children continue to be exposed to opioids every year. Further education on opioid sparing pain management strategies may be warranted to decrease opioid exposure, including the inappropriate use of codeine, in this low risk trauma population.
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Affiliation(s)
- Ashley A. Foster
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - John J. Porter
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Opioid prescribing patterns in emergency departments and future opioid use in adolescent patients. Am J Emerg Med 2019; 38:2297-2302. [PMID: 31784388 DOI: 10.1016/j.ajem.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Evidence suggests that exposure to opioids in adolescence increases risk of future opioid use. We evaluate if exposure to high versus low intensity opioid prescribers in the Emergency Department (ED) influences the risk of future opioid use in adolescents. METHODS Retrospective study of opioid-naïve patients 10 to 17 years seen in one of 14 EDs between January 2013 and December 2014. We categorized ED providers into quartiles according to the proportion of encounters resulting in opioid prescriptions. Primary outcome was use of opioids in the subsequent 12 months. Analysis adjusted for patient characteristics and compared future use of opioids for patients seen by the lowest versus the highest prescribing quartiles. RESULTS We included 9,688 patient encounters evaluated by the lowest opioid prescribing physician quartile versus 9,467 in the highest. The highest quartile gave opioid prescriptions to 14.9% of their patients compared to 2.8% for the lowest quartile. No association with future opioid use was found for patients evaluated by low versus high prescriber quartiles (OR 0.99, 95% CI 0.90-1.08). Patients with increasing age (OR 2.15, 95% CI 1.92-2.42) and white versus Hispanic ethnicity (OR 1.55, 95% CI 1.33-1.80) were associated with recurrent opioid use. CONCLUSION We found no association between high intensity opioid prescribers and recurrent 12 month use of opioids in opioid-naïve adolescents seen in the ED. This likely reflects various factors that put adolescents at risk for recurrent opioid use and may indicate the importance of the second prescription from primary care after initial exposure to opioids.
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Rizeq YK, Many BT, Vacek JC, Silver I, Goldstein SD, Abdullah F, Raval MV. Trends in perioperative opioid and non-opioid utilization during ambulatory surgery in children. Surgery 2019; 166:172-176. [DOI: 10.1016/j.surg.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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