Iobst Christopher A, Singh Satbir, Yang Jingzhen Z
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, United States.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):286-290. doi: 10.1016/j.jcot.2018.08.022. Epub 2018 Aug 31.
While hospitalizations attributed to opioid poisonings are increasing in the pediatric population, the patterns of prescribing behaviors of health care providers remains unclear. The aims of this study were to identify the opioid prescribing patterns of an orthopaedic team for post-surgical pediatric orthopaedic fracture patients, and to examine whether patient demographics, injury type, and type of providers were associated with the opioid prescribing patterns at discharge.
A retrospective chart review was performed among all patients aged 0-18 years undergoing surgery for elbow, forearm, wrist, femur, tibia and ankle fractures between 2014 and 2016 at a large children's hospital. Inclusion criteria were patients with isolated operative fractures involving the elbow, forearm, wrist, femur, tibia or ankle who received an opioid prescription at discharge prescribed by a member of the orthopaedic team. Exclusion criteria included patients discharged without opioids or patients discharged with opioid prescriptions from another medical team.
1000 unique patients (546 male) were identified, with average age of 7.9 years. The most common fracture was elbow (67.2%), followed by femur (12.4%), ankle (9.4%), forearm (5.8%), wrist (4.6%), and tibia (1.6%). Average dose of opioids prescribed was 28.4 (SD = 11.5) per patient. All prescriptions followed recommended guidelines for each medication. Patients who were older (p < 0.0001) or heavier (p < 0.0001) were prescribed a significantly greater average number of opioid doses. Nurse practitioners wrote 57.0% of the discharge prescriptions, followed by residents (23.0%) and physician assistants (14.5%). Attending surgeons accounted for only 5.5% of prescriptions. Residents and physician assistants prescribed significantly higher average doses than nurse practitioners and attending surgeons (p < 0.0001). Patients receiving liquid opioids received a statistically significant (p < 0.001) smaller number of doses than patients receiving tablets.
Pediatric orthopaedic trauma patients appear to be receiving generic numbers of opioid pain medication doses after fracture surgery due to universal rather than injury-specific prescribing patterns. Further study is required to determine the appropriate number of doses per injury type.
虽然儿科人群中因阿片类药物中毒导致的住院人数在增加，但医疗保健提供者的处方行为模式仍不清楚。本研究的目的是确定一个骨科团队为接受手术的儿科骨科骨折患者开具阿片类药物的处方模式，并检查患者的人口统计学特征、损伤类型和提供者类型是否与出院时的阿片类药物处方模式相关。
对2014年至2016年期间在一家大型儿童医院接受肘部、前臂、腕部、股骨、胫骨和踝关节骨折手术的所有0至18岁患者进行回顾性病历审查。纳入标准为孤立性手术骨折累及肘部、前臂、腕部、股骨、胫骨或踝关节且出院时接受骨科团队成员开具阿片类药物处方的患者。排除标准包括未使用阿片类药物出院的患者或由其他医疗团队开具阿片类药物处方出院的患者。
共识别出1000例独特患者（546例男性），平均年龄7.9岁。最常见的骨折部位是肘部（67.2%），其次是股骨（12.4%）、踝关节（9.4%）、前臂（5.8%）、腕部（4.6%）和胫骨（1.6%）。每位患者开具的阿片类药物平均剂量为28.4（标准差=11.5）。所有处方均遵循每种药物的推荐指南。年龄较大（p<0.0001）或体重较重（p<0.0001）的患者开具的阿片类药物平均剂量明显更多。执业护士开具了57.0%的出院处方，其次是住院医师（23.0%）和医师助理（14.5%）。主治外科医生仅占处方的5.5%。住院医师和医师助理开具的平均剂量明显高于执业护士和主治外科医生（p<0.0001）。接受液体阿片类药物的患者所接受的剂量在统计学上显著少于接受片剂的患者（p<0.001）。
由于普遍而非针对损伤的处方模式，儿科骨科创伤患者在骨折手术后似乎接受了大致相同数量的阿片类止痛药物剂量。需要进一步研究以确定每种损伤类型的合适剂量数量。
