Tapering Opioid Prescription Program for High-Risk Trauma Patients: A Pilot Randomized Controlled Trial

BACKGROUND

Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients.

AIMS

To assess the feasibility and acceptability of TOPP-Trauma, examine the feasibility of the research methods, and describe its potential efficacy in reducing long-term opioid use.

DESIGN

A two-arm pilot randomized controlled trial.

METHODS

Fifty participants discharged home were assigned to TOPP-Trauma or an educational pamphlet. Feasibility was assessed based on ability to provide the program components. The acceptability was assessed with the Treatment Acceptability and Preference Questionnaire. The feasibility of the research methods was evaluated according to standard parameters. Self-reported morphine equivalent dose (MED) and MEDs supplied by pharmacies were measured at 6 and 12 weeks.

RESULTS

Eighty percent or more of TOPP-Trauma components were delivered as planned, and the program was deemed highly acceptable. Approximately 10% of screened patients were eligible. Eighty-five percent of eligible patients agreed to participate with 20% attrition rates. TOPP-Trauma participants used less MED/day compared to the control group at 6 and 12 weeks (1.2. vs. 12.2 mg; 0.4. vs 4.0 mg), and pharmacies supplied less than half of cumulative MEDs to those who received the program at 12 weeks, but the differences were not statistically significant.

CONCLUSIONS

Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.

Feasibility of a tapering opioids prescription program for trauma patients at high risk of chronic consumption (TOPP-trauma): protocol for a pilot randomized controlled trial

BACKGROUND

Opioid use disorder (OUD) and deaths related to the chronic use of opioids have increased significantly over the last two decades. Chronic consumption of opioids has been documented in many patients with traumatic injuries. Preliminary research findings have shown that interventions using cognitive-behavioral strategies were a promising adjunct in decreasing the burden associated with opioid consumption. Accordingly, the Tapering Opioids Prescription Program in Trauma (TOPP-Trauma) was developed.

PURPOSE

To assess the feasibility of the TOPP-Trauma intervention and its research methods; and explore the potential efficacy of TOPP-Trauma in reducing opioid consumption.

METHODS

A 2-arm pilot randomized controlled trial (RCT) will be conducted in patients presenting a high risk for chronic opioid consumption. Fifty participants at high risk for chronic consumption of opioid will receive either TOPP-Trauma or an educational pamphlet. The feasibility assessment of TOPP-Trauma will be based on the ability to provide its components as initially planned. Several parameters will be evaluated to determine the feasibility of the research methods, including the adequacy of the sampling pool, the dropout rate, and the ease of data collection. The morphine equivalent dose (MED) per day between both groups will be measured at 6 and 12 weeks. Pain intensity and pain interference with activities will also be evaluated at the same time points.

DISCUSSION

This study will provide evidence on the feasibility of a preventive program aimed at reducing chronic opioid use in high risk trauma patients. Information will also be gathered on the methods that should be used to test the efficacy of such programs.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 40263056. Registered 26 May 2018.

Meckel's diverticulum in children: a 20-year review

Meckel's diverticulum occurs in 2% of the population and may present at any age. Its management, when found incidentally at laparotomy, remains controversial, particularly in the pediatric population. From 1970 to 1989, a Meckel's diverticulum was discovered in 164 children at laparotomy. There were 120 boys and 44 girls with a mean age of 5.2 years (range, 0 to 18 years). Forty-seven cases were asymptomatic, representing an incidental finding at laparotomy, 25 were resected, and ectopic gastric mucosa was present in 7 specimens (28%). Three postoperative deaths (6%) that were not related to the resection and 2 complications (4%) (postoperative leak and wound infection) occurred in this group. Of the 117 symptomatic patients, 49 (42%) presented with bowel obstruction, 45 (38%) had rectal bleeding, 16 (14%) had diverticulitis, and 7 (6%) had umbilical pathology. Volvulus (20) and intussusception (19) were the most common causes of obstruction. Predisposing factors for bowel obstruction were fibrous bands to umbilicus or mesentery (37%) and ectopic mucosa (35%). Severe painless rectal bleeding occurred in 45 patients, 30 of whom (67%) required blood transfusion. A nuclear medicine Meckel scan was positive in 32 of 37 patients (85%). Contrast studies were not diagnostic; colonoscopy and gastroscopy ruled out other causes of bleeding. Patients with diverticulitis (16) presented with acute abdominal pain compatible with appendicitis. In the symptomatic group, ectopic mucosa was present in 61% of the resected specimens. Gastric (88%), pancreatic (7%), and gastric with pancreatic (3%) were the most common ectopic tissue. Postoperative morbidity and mortality for symptomatic patients was 8.5% and 0%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)