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Titze N, Bhargava R, Montalvo AJ, Shin G, Haley CB, Saadat S, Chakravarthy B. Opioid prescription patterns in a children's hospital from 2012 to 2016. J Opioid Manag 2023; 19:489-494. [PMID: 38189190 DOI: 10.5055/jom.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVE Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time. METHODS 58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis, and the length of hospital stay with probability of opioid prescription. RESULTS 36,560 patients aged 0-21 years (mean: 10.5, median: 11.0, and standard deviation (SD): 7.42) received analgesic pain medications. 21,847 (59.8 percent) patients were prescribed more than one analgesic. There was a male predominance in patients <15 years of age; however, in adolescents >16 years, females constituted 57.1 percent of patients. Data also showed a statistically significant reduction of opioid prescriptions from 2012 to 2016 (p < 0.001). Age and length of hospital stay were directly associated with opioid prescription (p < 0.001). CONCLUSION Data show that there is a decrease in overall opioid prescriptions among pediatric patients, which may be secondary to new Food and Drug Administration regulations and increased awareness of morbidity associated with opioid use. Not surprisingly, increased hospital stay and increase in age lead to more analgesic prescriptions. Further investigation is needed to determine the differences within opioid prescription patterns.
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Affiliation(s)
- Nicole Titze
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrence, California
| | - Rishi Bhargava
- Department of Emergency Medicine, Miller Children's & Women's Hospital, Long Beach, California
| | - Ara Jamasbi Montalvo
- Department of Emergency Medicine, Golisano Children's Hospital, Rochester, New York
| | - Gawon Shin
- University of California Irvine, School of Medicine, Irvine, California. ORCID: https://orcid.org/0000-0001-9888-9853
| | | | - Soheil Saadat
- Department of Emergency Medicine, University of California Irvine, Irvine, California
| | - Bharath Chakravarthy
- Department of Emergency Medicine, University of California Irvine, Irvine, California
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Chun TH, Schnadower D, Casper TC, Sapién R, Tarr PI, O'Connell K, Roskind C, Rogers A, Bhatt S, Mahajan P, Vance C, Olsen CS, Powell EC, Freedman SB. Lack of Association of Household Income and Acute Gastroenteritis Disease Severity in Young Children: A Cohort Study. Acad Pediatr 2022; 22:581-591. [PMID: 34274521 PMCID: PMC10130956 DOI: 10.1016/j.acap.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE). METHODS We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens. RESULTS About 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions. CONCLUSIONS Lower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care.
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Affiliation(s)
- Thomas H Chun
- Department of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Brown University (TH Chun), Providence, RI
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine (D Schnadower), Cincinnati, Ohio
| | - T Charles Casper
- Department of Pediatrics, University of Utah (TC Casper), Salt Lake City, Utah
| | - Robert Sapién
- Department of Emergency Medicine, University of New Mexico Health Sciences Center (R Sapién), Albuquerque, NM
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine (PI Tarr), St. Louis, Mo
| | - Karen O'Connell
- Division of Emergency Medicine, Department of Pediatrics, Children's National Hospital, The George Washington School of Medicine and Health Sciences (K O'Connell), Washington, DC
| | - Cindy Roskind
- Department of Emergency Medicine, Columbia University College of Physicians & Surgeons (C Roskind), New York, NY
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan (A Rogers and P Mahajan), Ann Arbor, Mich
| | - Seema Bhatt
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (S Bhatt), Cincinnati, Ohio
| | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics, University of Michigan (A Rogers and P Mahajan), Ann Arbor, Mich; Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan Wayne State University (P Mahajan), Detroit, Mich
| | - Cheryl Vance
- Departments of Pediatrics and Emergency Medicine, University of California, Davis, School of Medicine (C Vance), Sacramento, Calif
| | - Cody S Olsen
- Department of Pediatrics, University of Utah (CS Olsen), Salt Lake City, Utah
| | - Elizabeth C Powell
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (EC Powell), Chicago, Ill
| | - Stephen B Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary (SB Freedman), Calgary, Alberta, Canada..
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