The use of opioids in low acuity pediatric trauma patients


Autoři: Ashley A. Foster aff001;  John J. Porter aff001;  Florence T. Bourgeois aff001;  Rebekah Mannix aff001
Působiště autorů: Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America aff001;  Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America aff002;  Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226433

Souhrn

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.

Klíčová slova:

Adolescents – Bone fracture – Critical care and emergency medicine – Musculoskeletal injury – Opioids – Pediatrics – Traumatic injury – Codeine


Zdroje

1. Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6):1108–16. doi: 10.1542/peds.2010-0791 21115581

2. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169–77. doi: 10.1542/peds.2015-1364 26504126

3. Lee LK, Mannix R. Increasing fatality rates from preventable deaths in teenagers and young adults. Jama. 2018;02115:E1–2.

4. Mazer-Amirshahi M, Mullins PM, Rasooly IR, van den Anker J, Pines JM, Peter Mullins ÞM, et al. Trends in prescription opioid use in pediatric emergency department patients. Pediatr Emerg Care. 2014;30(4):230–5. doi: 10.1097/PEC.0000000000000102 24651218

5. Axeen S, Seabury SA, Menchine M. Emergency department contribution to the prescription opioid epidemic. Ann Emerg Med. 2018;71(6):659–667.e3. doi: 10.1016/j.annemergmed.2017.12.007 29373155

6. Whitfill T, Auerbach M, Scherzer DJ, Shi J, Xiang H, Stanley RM. Emergency care for children in the United States: epidemiology and trends over time. J Emerg Med. 2018;(November 2017):1–12.

7. Poonai N, Bhullar G, Lin K, Papini A, Mainprize D, Howard J, et al. Oral administration of morphine versus ibuprofen to manage postfracture pain in children: A randomized trial. CMAJ. 2014;186(18):1358–63. doi: 10.1503/cmaj.140907 25349008

8. Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK. A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain. Ann Emerg Med. 2009;54(4):553–60. doi: 10.1016/j.annemergmed.2009.06.005 19692147

9. Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR. Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: A randomized clinical trial. Acad Emerg Med. 2009;16(8):711–6. doi: 10.1111/j.1553-2712.2009.00471.x 19624576

10. Tomaszewski DM, Arbuckle C, Yang S, Linstead E. Trends in opioid use in pediatric patients in US emergency departments from 2006 to 2015. JAMA Netw open. 2018;1(8):e186161. doi: 10.1001/jamanetworkopen.2018.6161 30646317

11. Niska R, Bhuiya F XJ. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Heal Stat Rep. 2010;(26):1–31.

12. McCaig LF, Burt CW. Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers. Ann Emerg Med. 2012;60(6):716–721.e1. doi: 10.1016/j.annemergmed.2012.07.010 23083968

13. Strayer R, Faaem F, Hayes B, Rosenbaum S, Richman M, Taylor S, et al. The treatment of acute pain in the emergency department: a white paper position statement prepared for the American Academy of Emergency Medicine. J Emerg Med. 2017;54(5):731–6.

14. Optimizing the treatment of acute pain in the emergency department. Ann Emerg Med. 2017;70(3):446–8.

15. National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS) - 2006–2015. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS. Accessed 12/01/2019.

16. National Center for Health Statistics. 2015 National Hospital Ambulatory Medical Care Survey Emergency Department Public Use Data File Documentation. 2015;1–156.

17. Hudgins JD, Monuteaux MC, Bourgeois FT, Nigrovic LE, Fine AM, Lee LK, et al. Complexity and severity of pediatric patients treated at United States emergency departments. J Pediatr. 2017;186:145–149.e1. doi: 10.1016/j.jpeds.2017.03.035 28396022

18. Mannix R, Bourgeois FT, Schutzman SA, Bernstein A, Lee LK. Neuroimaging for pediatric head trauma: do patient and hospital characteristics influence who gets imaged? Acad Emerg Med. 2010;17(7):694–700. doi: 10.1111/j.1553-2712.2010.00797.x 20653582

19. Tobias JD, Green TP, Cote CJ. Codeine: time to say “no.” Pediatrics. 2016;138(4):e20162396–e20162396. doi: 10.1542/peds.2016-2396 27647717

20. Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Holubkov R, Gorelick MH. Developing a diagnosis-based severity classification system for use in emergency medical services for children. Acad Emerg Med. 2012;19(1):70–8. doi: 10.1111/j.1553-2712.2011.01250.x 22251193

21. Levy P, Lemeshow S. Sampling of Populations. Hoboken, NJ: John Wiley & Sons, Inc.; 2011. 517–536 p.

22. Allen JD, Casavant MJ, Spiller HA, Chounthirath T, Hodges NL, Smith GA. Prescription opioid exposures among children and adolescents in the United States 2000–2015. Pediatrics. 2017;139(4):e20163382. doi: 10.1542/peds.2016-3382 28320869

23. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(SPEC. ISS. 2):105–20.

24. Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Trends in opioid prescribing for adolescents and young adults in ambulatory care settings. Pediatrics. 2019;143(6).

25. Guy GP, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital signs: Changes in opioid prescribing in the United States, 2006–2015. Morb Mortal Wkly Rep. 2017;66(26):697–704.

26. Groenewald CB, Rabbitts JA, Gebert T, Palermo TM. Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012. Pain. 2016;157(5):1021–7. doi: 10.1097/j.pain.0000000000000475 26716995

27. Groenewald CB, Rabbitts JA, Hansen EE, Palermo TM. Racial differences in opioid prescribing for children in the United States. Pain. 2018;159(10):2050–7. doi: 10.1097/j.pain.0000000000001290 29794611

28. Rasooly IR, Mullins PM, Mazer-Amirshahi M, Van Den Anker J, Pines JM. The impact of race on analgesia use among pediatric emergency department patients. J Pediatr. 2014;165(3):618–21. doi: 10.1016/j.jpeds.2014.04.059 24928697

29. Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996–1002. doi: 10.1001/jamapediatrics.2015.1915 26366984

30. Ortega HW, Vander Velden H, Lin C-W, Reid S. Race, ethnicity, and analgesia provision at discharge among children with long-bone fractures requiring emergency care. Pediatr Emerg Care. 2013;29(4):492–7. doi: 10.1097/PEC.0b013e31828a34a8 23528513

31. Scully R, Chowdhury R, Sharma M, Nitzschke S. Incidence and predictors of opioid prescription at discharge after traumatic injury. 2017;02120:1–7.

32. Whiteside LK, Joan R, Wang J, Ranney ML, Neamc V, Zatzick DF. Predictors of sustained prescription opioid use after admission for trauma in Adolescents. J Adolesc Heal. 2016;58(1):92–7.

33. Kaiser S V., Asteria-Penaloza R, Vittinghoff E, Rosenbluth G, Cabana MD, Bardach NS. National patterns of codeine prescriptions for children in the emergency department. Pediatrics. 2014;133(5):e1139–47. doi: 10.1542/peds.2013-3171 24753533

34. Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department. Jama. 2017;318(17):1661. doi: 10.1001/jama.2017.16190 29114833

35. Schuman SS, Regen RB, Stuart LH, Harrell C, Jones TL, Stewart BM, et al. Reducing time to pain medication administration for pediatric patients with long bone fractures in the emergency department. Pediatr Qual Saf. 2018;3(6):e120. doi: 10.1097/pq9.0000000000000120 31334452

36. Poonai N, Datoo N, Ali S, Cashin M, Drendel AL, Zhu R, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: A randomized controlled trial. Cmaj. 2017;189(40):E1252–8. doi: 10.1503/cmaj.170017 29018084

37. Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376(7):663–73. doi: 10.1056/NEJMsa1610524 28199807

38. Butler MM, Ancona RM, Beauchamp GA, Yamin CK, Winstanley EL, Hart KW, et al. Emergency department prescription opioids as an initial exposure presceding addiction. Ann Emerg Med. 2016;68(2):202–8. doi: 10.1016/j.annemergmed.2015.11.033 26875061

39. Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141(1):1–11.

40. Williams DG, Patel A, Howard RF. Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. Br J Anaesth. 2002;89(6):839–45. doi: 10.1093/bja/aef284 12453926


Článek vyšel v časopise

PLOS One


2019 Číslo 12