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Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures. Pain Med 2020 Sep 01;21(9):1947-1954

Date

02/06/2020

Pubmed ID

32022894

Pubmed Central ID

PMC7553018

DOI

10.1093/pm/pnz348

Scopus ID

2-s2.0-85090816227   8 Citations

Abstract

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 18 years 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.

Author List

Drendel AL, Brousseau DC, Casper TC, Bajaj L, Alessandrini EA, Grundmeier RW, Chamberlain JM, Goyal MK, Olsen CS, Alpern ER

Authors

David Brousseau MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Amy L. Drendel DO Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Analgesics, Opioid
Child
Child, Preschool
Emergency Service, Hospital
Fractures, Bone
Humans
Patient Discharge
Practice Patterns, Physicians'
Prescriptions
Retrospective Studies