Livingstone Margaret J, Groenewald Cornelius B, Rabbitts Jennifer A, Palermo Tonya M
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Paediatr Anaesth. 2017 Jan;27(1):19-27. doi: 10.1111/pan.13033. Epub 2016 Oct 25.
Concerns regarding the safety of codeine have been raised. Cases of life-threatening respiratory depression and death in children have been attributed to codeine's polymorphic metabolic pathway. International health agencies recommend restricted use of codeine in children. Despite these recommendations, the epidemiology of codeine use among children remains unknown.
Our objective was to examine patterns of codeine use in the US among children.
A cross-sectional analysis of children of age 0-17 years from 1996 to 2013 in the US was performed. Data were extracted from MEPS, a nationally representative set of health care surveys. Prevalence rates of codeine use between 1996 and 2013 were examined. Multivariable logistic regression examined relationships between codeine use and patient demographics.
Codeine use remained largely unchanged from 1996 to 2013 (1.08 vs 1.03 million children, respectively). Odds of codeine use was higher in ages 12-17 (OR, 1.40; [1.21-1.61]), outside of the Northeastern US, and among those with poor physical health status (OR, 3.29 [1.79-6.03]). Codeine use was lower in children whose ethnicity was not white and those uninsured (OR, 0.47 [0.34-0.63]). Codeine was most frequently prescribed by emergency physicians (18%) and dentists (14%). The most common condition associated with codeine use was trauma-related pain.
Pediatric codeine use has declined since 1996; however, more than 1 million children still used codeine in 2013. Health care providers must be made aware of guidelines advising against the use of codeine in children. Codeine is potentially hazardous and safer alternatives to treat children's pain are available.
人们对可待因的安全性提出了担忧。儿童出现危及生命的呼吸抑制和死亡病例被归因于可待因的多态性代谢途径。国际卫生机构建议限制可待因在儿童中的使用。尽管有这些建议，但儿童使用可待因的流行病学情况仍不为人所知。
我们的目标是研究美国儿童使用可待因的模式。
对1996年至2013年美国0至17岁儿童进行横断面分析。数据从医疗支出面板调查（MEPS）中提取，这是一组具有全国代表性的医疗保健调查。研究了1996年至2013年期间可待因使用的患病率。多变量逻辑回归分析了可待因使用与患者人口统计学特征之间的关系。
1996年至2013年期间，可待因的使用情况基本保持不变（分别为108万和103万儿童）。12至17岁儿童、美国东北部以外地区的儿童以及身体健康状况较差的儿童使用可待因的几率更高（比值比[OR]，1.40；[1.21 - 1.61]）。非白人儿童和未参保儿童使用可待因的几率较低（OR，0.47 [0.34 - 0.63]）。可待因最常由急诊医生（18%）和牙医（14%）开具。与可待因使用相关的最常见病症是创伤相关疼痛。
自1996年以来，儿科可待因的使用有所下降；然而，2013年仍有超过100万儿童使用可待因。必须让医疗保健提供者了解不建议在儿童中使用可待因的指南。可待因有潜在危害，并且有更安全的替代方法来治疗儿童疼痛。
