DePhillips Michelle, Watts Jennifer, Lowry Jennifer, Dowd M Denise
From the Departments of Emergency Medicine and.
Pharmacology, Toxicology, and Therapeutic Innovations, Children's Mercy Hospital, Kansas City, MO.
Pediatr Emerg Care. 2019 Jan;35(1):16-21. doi: 10.1097/PEC.0000000000001239.
Deaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children's hospital system.
This retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written. The primary outcome was number of days of opioid prescribed. Other data collected included patient demographics, diagnosis, and prescriber information; factors associated with prescriptions written for more than 5 days were identified.
A total of 4075 opioid prescriptions were included in the 1-year study period, and 3991 of these had complete data for analysis. The median amount prescribed was 3.3 days with an interquartile range of 2.5 days. Odds of receiving a prescription of more than 5 days' duration were higher for children younger than 1 year (odds ratio [OR], 12.3; 95% confidence interval [CI], 7.3-21.0), 1 to 4 years of age (OR, 7.7; 95% CI, 5.5-10.8), and 5 to 9 years of age (OR, 2.4; 95% CI, 1.7-3.4); for children with noninjury diagnoses (OR, 1.4; 95% CI, 1.2-1.7); or if prescribed by a resident physician (OR, 1.4; 95% CI, 1.1-1.8) or from the urgent care (OR, 1.4; 95% CI, 1.1-1.7).
Opioid prescriptions of more than 5 days were more frequently prescribed for younger patients, noninjury diagnoses, or if prescribed by a resident physician or from the urgent care. We need to focus on medical student, resident, and provider education as well as further opioid research in order to decrease unnecessary prescribing.
因处方阿片类药物过量导致的死亡人数处于创纪录高位。有人建议限制阿片类药物的处方量作为一种预防策略。本研究的目的是描述一家中西部三级儿童医疗系统的急诊科和紧急护理点的阿片类药物处方情况。
这项回顾性病历审查研究了该系统中2家儿科急诊科和2家儿科紧急护理点在2012年6月1日至2013年5月31日期间的就诊情况，在此期间开具了门诊阿片类药物处方。主要结局是阿片类药物的处方天数。收集的其他数据包括患者人口统计学信息、诊断结果和开处方者信息；确定了与开具超过5天处方相关的因素。
在为期1年的研究期间，共纳入4075份阿片类药物处方，其中3991份有完整数据用于分析。处方天数的中位数为3.3天，四分位间距为2.5天。1岁以下儿童（比值比[OR]，12.3；95%置信区间[CI]，7.3 - 21.0）、1至4岁儿童（OR，7.7；95% CI，5.5 - 10.8）以及5至9岁儿童（OR，2.4；95% CI，1.7 - 3.4）开具超过5天处方的几率更高；非受伤诊断的儿童（OR，1.4；95% CI，1.2 - 1.7）；或者由住院医师开具处方（OR，1.4；95% CI，1.1 - 1.8）或来自紧急护理点开具的处方（OR，1.4；95% CI，1.1 - 1.7）。
对于较年轻患者、非受伤诊断的患者，或者由住院医师或从紧急护理点开具的处方，开具超过5天的阿片类药物处方更为常见。我们需要关注医学生、住院医师和医疗服务提供者的教育以及进一步的阿片类药物研究，以减少不必要的处方。
