Opioid exposure after injury in United States trauma centers: A prospective, multicenter observational study. J Trauma Acute Care Surg 2020 Jun;88(6):816-824
Date
05/28/2020Pubmed ID
32459447Pubmed Central ID
PMC7802946DOI
10.1097/TA.0000000000002679Scopus ID
2-s2.0-85085539142 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
BACKGROUND: Efforts to reduce opioid use in trauma patients are currently hampered by an incomplete understanding of the baseline opioid exposure and variation in United States. The purpose of this project was to obtain a global estimate of opioid exposure following injury and to quantify the variability of opioid exposure between and within United States trauma centers.
STUDY DESIGN: Prospective observational study was performed to calculate opioid exposure by converting all sources of opioids to oral morphine milligram equivalents (MMEs). To estimate variation, an intraclass correlation was calculated from a multilevel generalized linear model adjusting for the a priori selected variables Injury Severity Score and prior opioid use.
RESULTS: The centers enrolled 1,731 patients. The median opioid exposure among all sites was 45 MMEs per day, equivalent to 30 mg of oxycodone or 45 mg of hydrocodone per day. Variation in opioid exposure was identified both between and within trauma centers with the vast majority of variation (93%) occurring within trauma centers. Opioid exposure increased with injury severity, in male patients, and patients suffering penetrating trauma.
CONCLUSION: The overall median opioid exposure was 45 MMEs per day. Despite significant differences in opioid exposure between trauma centers, the majority of variation was actually within centers. This suggests that efforts to minimize opioid exposure after injury should focus within trauma centers and not on high-level efforts to affect all trauma centers.
LEVEL OF EVIDENCE: Epidemiological, level III.
Author List
Harvin JA, Truong VTT, Green CE, Allen L, Murry J, Radosevich JJ, Bogert JN, Murphy PB, Padilla-Jones BB, Zarzaur BL, Taylor JR, Sexton KW, Decker C, Schroeppel TJ, Wade CE, Kao LSAuthor
Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Analgesics, Opioid
Drug Utilization
Female
Humans
Injury Severity Score
Length of Stay
Male
Middle Aged
Pain
Pain Management
Practice Patterns, Physicians'
Prospective Studies
Sex Factors
Trauma Centers
United States
Wounds and Injuries
