학술논문
Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures
ACUTE & PERIOPERATIVE PAIN SECTION
ACUTE & PERIOPERATIVE PAIN SECTION
Document Type
Report
Author
Source
Pain Medicine. September 2020, Vol. 21 Issue 9, p1947, 8 p.
Subject
Language
English
ISSN
1526-2375
Abstract
Introduction Pain is the most common reason for seeking health care in the emergency department (ED) for both adults and children [1-4]. The current opioid abuse epidemic poses challenges for [...]
Objective. To measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. Design. A retrospective cohort study of pediatric ED visits in 2015. Setting. Four pediatric EDs. Subjects. Children aged four to 18years with a long-bone fracture discharged from the ED. Methods. A multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription. Results. There were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A =8.2% (95% confidence interval [CI] = 6.9-9.7%), B=12.1% (95% CI = 10.5-14.0%), C=16.9% (95% CI = 15.2-18.8%), D=23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing. Conclusions. For children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking. Key Words: Pediatric; Pain, Opioid, Fracture
Objective. To measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. Design. A retrospective cohort study of pediatric ED visits in 2015. Setting. Four pediatric EDs. Subjects. Children aged four to 18years with a long-bone fracture discharged from the ED. Methods. A multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription. Results. There were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A =8.2% (95% confidence interval [CI] = 6.9-9.7%), B=12.1% (95% CI = 10.5-14.0%), C=16.9% (95% CI = 15.2-18.8%), D=23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing. Conclusions. For children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking. Key Words: Pediatric; Pain, Opioid, Fracture