1
|
Hill DM, Reger M, Todor LA, Boyd AN, Cogle S, DeWitt A, Drabick Z, Faris J, Zavala S, Adams B, Alexander KM, Carter K, Gayed RM, Gutenschwager DW, Hall A, Hansen M, Krantz EN, Pham F, Quan AN, Smith L, Tran N, Walroth TA, Mueller SW. An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury. J Burn Care Res 2024; 45:614-624. [PMID: 38285011 DOI: 10.1093/jbcr/irae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 01/30/2024]
Abstract
Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search returned 2336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high-impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
Collapse
Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Lorraine A Todor
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Allison N Boyd
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Sarah Cogle
- Pharmacy Clinical Programs, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Alexandra DeWitt
- Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA 70112, USA
| | - Zachary Drabick
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Janie Faris
- Department of Pharmacy, Parkland Health & Hospital System, Dallas, TX 35235, USA
| | - Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Kaitlin M Alexander
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
| | - Kristen Carter
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
| | - Rita M Gayed
- Department of Pharmacy and Medical Nutrition, Grady Burn Center, Atlanta, GA 71644, USA
| | | | - Alexandria Hall
- Department of Pharmacy, Harborview Medical Center, Seattle, WA 98104, USA
| | - Meaghan Hansen
- Department of Pharmacy, UPMC Mercy, Pittsburgh, PA 15219, USA
| | - Erica N Krantz
- Department of Pharmacy, Ascension Via Christi, Wichita, KS 67214, USA
| | - Felix Pham
- Department of Pharmacy, Torrance Memorial Medical Center, Torrance, CA 90505, USA
| | - Asia N Quan
- Department of Pharmacy, The Arizona Burn Center Valleywise Health, Phoenix, AZ 85008, USA
| | - Lisa Smith
- Department of Pharmacy, Doctors Hospital, Augusta, GA 30909, USA
| | - Nicolas Tran
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Health, Aurora, CO 80045, USA
| |
Collapse
|
2
|
Jamal S, Shaw M, Quasim T, Puxty K, McGovern C. Long term opioid use after burn injury: a retrospective cohort study. Br J Anaesth 2024; 132:599-606. [PMID: 38216388 PMCID: PMC10870133 DOI: 10.1016/j.bja.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Patients who have survive a burn injury might be at risk of opioid dependence after discharge. This study examined the use of opioids in patients who suffer burn injury and explored factors associated with persistent opioid use after hospital discharge. METHODS This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched comparison cohorts from the general population and adults with a diagnosis of acute pancreatitis. Pre-admission prescription opioid use was determined, and a multivariable negative binomial regression analysis used to explore post-discharge opioid use. RESULTS A total of 7147 burn patients were matched with 6810 pancreatitis patients and with 28 184 individuals from the general population. Pre-admission opioid use was higher in the burn and pancreatitis cohorts (29% and 40%, respectively) compared with the general population (17%). Opioid use increased in both burn and pancreatitis cohorts after discharge (41% and 53%, respectively), although patients with pancreatitis were at even higher risk of increased opioid use in an adjusted analysis (incidence rate ratio 1.43). Female sex, lower socioeconomic status, ICU admission, pre-injury opioid use, and a history of excess alcohol use were all associated with an increase in opioid prescriptions after discharge. CONCLUSIONS Opioid use is high in those admitted with a burn injury or acute pancreatitis when compared with the general population, increasing further after hospital discharge. Female sex and socioeconomic deprivation are among factors that make increased opioid use more likely, although this phenomenon seems even more pronounced in those with acute pancreatitis compared with burn injuries.
Collapse
Affiliation(s)
- Sherzah Jamal
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kathryn Puxty
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | |
Collapse
|
3
|
Armstrong M, Groner JI, Samora J, Olbrecht VA, Tram NK, Noffsinger D, Boyer EW, Xiang H. Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: An epidemiologic study. PLoS One 2023; 18:e0294279. [PMID: 37972014 PMCID: PMC10653505 DOI: 10.1371/journal.pone.0294279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. METHODS The retrospective chart review included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. Prospectively, legal guardians completed a survey for a convenience sample of 50 patients. Opioid medications (days and morphine milligram equivalents (MMEs)/kg) prescribed at discharge before and after the Ohio law implementation were collected. Guardians reported experience and satisfaction with their child's opioid prescription at 90-days post discharge. RESULTS From pre-law to post-law, there was a significant decrease (p<0.001) within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total MMEs prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). An interrupted time series analysis revealed a statistically significant decrease in MMEs/kg and days prescribed at discharge when the 2017 Ohio opioid prescription law went into effect, with an abrupt level change. Prospectively, more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee). Inpatient opioid use was not changed pre- and post-law. CONCLUSIONS Discharge opioids prescribed for pediatric burn and knee arthroscopy procedures has decreased from 2015-2019. Caregivers varied greatly in their satisfaction with pain control and the amount of opioid prescribed.
Collapse
Affiliation(s)
- Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Jonathan I. Groner
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Samora
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Orthopedics, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Vanessa A. Olbrecht
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Nguyen K. Tram
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| |
Collapse
|
4
|
Brunson DC, Miller KA, Matheson LW, Carrillo E. Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury. JAMA Netw Open 2023; 6:e2338070. [PMID: 37847499 PMCID: PMC10582796 DOI: 10.1001/jamanetworkopen.2023.38070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Racial and ethnic disparities in pain management have been characterized in many hospital-based settings. Painful traumatic injuries are a common reason for 911 activations of the EMS (emergency medical services) system. Objective To evaluate whether, among patients treated by EMS with traumatic injuries, race and ethnicity are associated with either disparate recording of pain scores or disparate administration of analgesia when a high pain score is recorded. Design, Settings, and Participants This cohort study included interactions from 2019 to 2021 for US patients ages 14 to 99 years who had experienced painful acute traumatic injuries and were treated and transported by an advanced life support unit following the activation of the 911 EMS system. The data were analyzed in January 2023. Exposures Acute painful traumatic injuries including burns. Main Outcomes and Measures Outcomes were the recording of a pain score and the administration of a nonoral opioid or ketamine. Results The study cohort included 4 781 396 EMS activations for acute traumatic injury, with a median (IQR) patient age of 59 (35-78) years (2 497 053 female [52.2%]; 31 266 American Indian or Alaskan Native [0.7%]; 59 713 Asian [1.2%]; 742 931 Black [15.5%], 411 934 Hispanic or Latino [8.6%], 10 747 Native Hawaiian or other Pacific Islander [0.2%]; 2 764 499 White [57.8%]; 16 161 multiple races [0.3%]). The analysis showed that race and ethnicity was associated with the likelihood of having a pain score recorded. Compared with White patients, American Indian and Alaskan Native patients had the lowest adjusted odds ratio (AOR) of having a pain score recorded (AOR, 0.74; 95% CI, 0.71-0.76). Among patients for whom a high pain score was recorded (between 7 and 10 out of 10), Black patients were about half as likely to receive opioid or ketamine analgesia as White patients (AOR, 0.53; 95% CI, 0.52-0.54) despite having a pain score recorded almost as frequently as White patients. Conclusions and Relevance In this nationwide study of patients treated by EMS for acute traumatic injuries, patients from racial or ethnic minority groups were less likely to have a pain score recorded, with Native American and Alaskan Natives the least likely to have a pain score recorded. Among patients with a high pain score, patients from racial and ethnic minority groups were also significantly less likely to receive opioid or ketamine analgesia treatment, with Black patients having the lowest adjusted odds of receiving these treatments.
Collapse
Affiliation(s)
- Dalton C. Brunson
- School of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Kate A. Miller
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Loretta W. Matheson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Eli Carrillo
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
5
|
Richman M, Berman JM, Ross EM. Regional Anesthesia Use in Pediatric Burn Surgery: A Descriptive Retrospective Series. Cureus 2021; 13:e19063. [PMID: 34853768 PMCID: PMC8608680 DOI: 10.7759/cureus.19063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Pediatric burns are a common and often devastating injury. Treatment, reconstruction, and rehabilitation are painful experiences. For some, the experience triggers post-traumatic stress disorder and/or a chronic pain syndrome. Given the role pain plays as a major secondary disease, it must be addressed to achieve optimal healing. Regional anesthesia has been used extensively to manage postoperative pain and reduce the need for opioids following other surgical procedures in children. However, regional anesthesia is not widely used in pediatric burn care. We present a descriptive, retrospective case series of 15 pediatric burn patients who received regional anesthesia as part of their intra-operative pain management. In our patient population, we saw low levels of anesthetic as well as opioid usage with well-controlled pain. In this cohort, 93% of patients scored a 0/10 on the Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain by post-anesthesia care unit (PACU) discharge, with an average PACU stay of 70 minutes. Thirty-three percent of patients received no opioids, with the average opioid dose being 0.06mg/kg morphine equivalents. This case series serves to make clinicians aware of the feasibility of use and benefits of regional anesthesia in pediatric burn patients requiring operative repair.
Collapse
Affiliation(s)
- Michael Richman
- Department of Pediatric Anesthesiology, Seattle Children's Hospital, Seattle, USA
| | - Jeffrey M Berman
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Elizabeth M Ross
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|