Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome

Autoři: Lauren K. Dunn aff001;  Davis G. Taylor aff002;  Samantha J Smith aff001;  Alexander J. Skojec aff001;  Tony R. Wang aff002;  Joyce Chung aff001;  Mark F. Hanak aff001;  Christopher D. Lacomis aff001;  Justin D. Palmer aff001;  Caroline Ruminski aff001;  Shenghao Fang aff001;  Siny Tsang aff003;  Sarah N. Spangler aff001;  Marcel E. Durieux aff001;  Bhiken I. Naik aff001
Působiště autorů: Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America aff001;  Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America aff002;  Nutrition and Exercise Physiology, Washington State University, Spokane, Washington, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225787


Traumatic brain injury (TBI) is associated with increased risk for psychological and substance use disorders. The study aim is to determine incidence and risk factors for persistent opioid prescription after hospitalization for TBI. Electronic medical records of patients age ≥ 18 admitted to a neuroscience intensive care unit between January 2013 and February 2017 for an intracranial injury were retrospectively reviewed. Primary outcome was opioid use through 12 months post-hospital discharge. A total of 298 patients with complete data were included in the analysis. The prevalence of opioid use among preadmission opioid users was 48 (87%), 36 (69%) and 22 (56%) at 1, 6 and 12-months post-discharge, respectively. In the opioid naïve group, 69 (41%), 24 (23%) and 17 (19%) were prescribed opioids at 1, 6 and 12 months, respectively. Preadmission opioid use (OR 324.8, 95% CI 23.1–16907.5, p = 0.0004) and higher opioid requirements during hospitalization (OR 4.5, 95% CI 1.8–16.3, p = 0.006) were independently associated with an increased risk of being prescribed opioids 12 months post-discharge. These factors may be used to identify and target at-risk patients for intervention.

Klíčová slova:

Antidepressants – Antipsychotics – Hospitals – Intensive care units – NSAIDs – Opioids – Surgical and invasive medical procedures – Traumatic brain injury


1. Injury GBDTB, Spinal Cord Injury C. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):56–87. Epub 2018/12/01. doi: 10.1016/S1474-4422(18)30415-0 30497965

2. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1–16. Epub 2017/03/17. doi: 10.15585/mmwr.ss6609a1 28301451

3. Shukla D, Devi BI, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg. 2011;113(6):435–41. Epub 2011/03/29. doi: 10.1016/j.clineuro.2011.02.013 21440363.

4. van der Naalt J, Timmerman ME, de Koning ME, van der Horn HJ, Scheenen ME, Jacobs B, et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7):532–40. Epub 2017/06/28. doi: 10.1016/S1474-4422(17)30117-5 28653646.

5. Vaughn MG, Salas-Wright CP, John R, Holzer KJ, Qian Z, Veeh C. Traumatic Brain Injury and Psychiatric Co-Morbidity in the United States. Psychiatr Q. 2018. Epub 2018/11/23. doi: 10.1007/s11126-018-9617-0 30465326.

6. Colton K, Yang S, Hu PF, Chen HH, Bonds B, Stansbury LG, et al. Pharmacologic Treatment Reduces Pressure Times Time Dose and Relative Duration of Intracranial Hypertension. J Intensive Care Med. 2016;31(4):263–9. Epub 2014/10/17. doi: 10.1177/0885066614555692 25320157.

7. Sandiumenge Camps A, Sanchez-Izquierdo Riera JA, Toral Vazquez D, Sa Borges M, Peinado Rodriguez J, Alted Lopez E. Midazolam and 2% propofol in long-term sedation of traumatized critically ill patients: efficacy and safety comparison. Crit Care Med. 2000;28(11):3612–9. Epub 2000/12/01. doi: 10.1097/00003246-200011000-00009 11098962.

8. Alnemari AM, Krafcik BM, Mansour TR, Gaudin D. A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury. World Neurosurg. 2017;106:509–28. Epub 2017/07/18. doi: 10.1016/j.wneu.2017.07.009 28712906.

9. Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS, et al. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20(1):128. Epub 2016/05/06. doi: 10.1186/s13054-016-1294-5 27145814

10. Wiener J, McIntyre A, Janzen S, Mirkowski M, MacKenzie HM, Teasell R. Opioids and cerebral physiology in the acute management of traumatic brain injury: a systematic review. Brain Inj. 2019:1–8. Epub 2019/01/31. doi: 10.1080/02699052.2019.1574328 30696281.

11. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017:e170504. doi: 10.1001/jamasurg.2017.0504 28403427.

12. Dunn LK, Yerra S, Fang S, Hanak MF, Leibowitz MK, Tsang S et al. Incidence and risk factors for chronic postoperative opioid use after major spine surgery: a cross-sectional study with longitudinal outcome. Anesth Analg. 2018.

13. Sun Y, Li T, Wang N, Yun Y, Gan TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2012;55(11):1183–94. Epub 2012/10/10. doi: 10.1097/DCR.0b013e318259bcd8 23044681.

14. Portenoy R, Z M, A E. Cancer pain management with opioids: Optimizing analgesia Waltham, MA: UpToDate; 2017 [updated May 26, 2017].

15. Team RDC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2015. Retrieved from

16. Wang HT, Hill AD, Gomes T, Wijeysundera DN, Pinto R, Scales DC, et al. Opioid Use After ICU Admission Among Elderly Chronic Opioid Users in Ontario: A Population-Based Cohort Study. Crit Care Med. 2018;46(12):1934–42. Epub 2018/09/18. doi: 10.1097/CCM.0000000000003401 30222633.

17. Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent Opioid Use After Wisdom Tooth Extraction. JAMA. 2018;320(5):504–6. Epub 2018/08/09. doi: 10.1001/jama.2018.9023 30088000

18. Shehabi Y, Howe BD, Bellomo R, Arabi YM, Bailey M, Bass FE, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med. 2019;380(26):2506–17. Epub 2019/05/22. doi: 10.1056/NEJMoa1904710 31112380.

19. Zhao H, Yang S, Wang H, Zhang H, An Y. Non-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis. J Crit Care. 2019;54:136–44. Epub 2019/08/26. doi: 10.1016/j.jcrc.2019.08.022 31446231.

20. Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):e825–e73. Epub 2018/08/17. doi: 10.1097/CCM.0000000000003299 30113379.

21. Hudson TJ, Painter JT, Gressler LE, Lu L, Williams JS, Booth BM, et al. Factors Associated with Opioid Initiation in OEF/OIF/OND Veterans with Traumatic Brain Injury. Pain Med. 2018;19(4):774–87. Epub 2017/10/17. doi: 10.1093/pm/pnx208 29036680.

Článek vyšel v časopise


2019 Číslo 11