Citation

Pelaez CA, Davis JW, Spilman SK, Guzzo HM, Wetjen KM, Randell KA, Ortega HW, Pitcher GJ, Kenardy J, Ramirez MR. J. Am. Coll. Surg. 2019; ePub(ePub): ePub.

Affiliation

Injury Prevention Research Center, The University of Iowa, Iowa City, IA; Division of Environmental Health Sciences, The University of Minnesota, Minneapolis, MN.

Copyright

(Copyright © 2019, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2019.05.021

PMID

31125609

Abstract

BACKGROUND: Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. STUDY DESIGN: This is a secondary analysis of data collected for a randomized, prospective intervention study at four Midwestern children's trauma centers. Participants included children ages 10-17 years admitted to the hospital for unintentional injury. Descriptive statistics and multivariable modeling were used to characterize demographic factors and measure prevalence and magnitude of opioid use within the first 48 hours of hospitalization.

RESULTS: Among 299 participants, 82% received at least one opioid administration. Children had increased odds of receiving an opioid (OR=4.25; 95% CI=2.16-8.35) for every log increase of Injury Severity Scores (ISS), yet the majority of children with minor injury (61%) also received an opioid. Children with fractures and older children had higher odds of receiving an opioid. Amount of opioid, expressed as morphine milligrams equivalent (MME), significantly increased with child age, ISS, and fracture.

CONCLUSION: Most pediatric trauma patients received an opioid in the first 48 hours of hospitalization, although prevalence and exposure varied by age, injury, and acuity. Aggressive pain management can be appropriate for injured pediatric patients; however, study results indicate areas for improvement, specifically for children with minor injuries and those receiving excessive opioid amounts.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

hospitalization; morphine milligrams equivalent (MME); opioids; pain management; pediatric trauma; unintentional injury