Mazer-Amirshahi Maryann, Mullins Peter M, Rasooly Irit R, van den Anker John, Pines Jesse M
From the *Department of Emergency Medicine, The George Washington University; †The George Washington University School of Medicine and Health Sciences; ‡Department of Pediatrics, The George Washington University; and §Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC.
Pediatr Emerg Care. 2014 Apr;30(4):230-5. doi: 10.1097/PEC.0000000000000102.
In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade.
Data from the 2001-2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (≤19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis.
The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P < 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086).
Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics.
近年来，急诊科对疼痛治疗的重视程度不断提高，与此同时，人们对处方阿片类药物的滥用可能性也日益担忧。在本研究中，我们描述了过去十年美国急诊科儿科患者阿片类药物处方的趋势。
分析2001 - 2010年国家医院门诊医疗调查的数据，确定与疼痛相关的就诊情况。按年龄类别和年份列出儿科患者（≤19岁）在与疼痛相关的急诊科就诊时使用或开具阿片类镇痛药的情况。分析的特定阿片类药物包括可待因、氢可酮、氢吗啡酮、吗啡和羟考酮。还调查了非阿片类镇痛药的使用模式。结果根据药品执法管理局的分类和与疼痛相关的诊断进一步分层。
2001年至2010年间，儿科急诊科与疼痛相关就诊中阿片类镇痛药的总体使用从11.2%增加到14.5%（P = 0.015）。药品执法管理局二类药物的使用从2001年的3.6%翻倍至2010年的7.0%（P < 0.001），而三类、四类和五类药物的使用没有显著增加（P = 0.34）。氢可酮是最常开具的阿片类镇痛药。阿片类药物使用增加在涉及青少年的急诊科就诊中最为显著。儿科急诊科患者中非阿片类镇痛药的使用没有显著增加（P = 0.086）。
2001年至2010年间，儿科急诊科与疼痛相关就诊中阿片类药物的使用显著增加，尤其是在青少年中。急诊科医护人员必须警惕在缓解疼痛与将阿片类镇痛药的不良反应降至最低之间取得平衡。
