Phang Karina G, Roberts James R, Ebeling Myla, Garner Sandra S, Basco William T
Geisinger Medical Center, Danville, Pennsylvania; and
Medical University of South Carolina, Charleston, South Carolina.
Pediatrics. 2020 Aug;146(2). doi: 10.1542/peds.2019-3690. Epub 2020 Jul 2.
To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care.
We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting.
Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites.
School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.
根据就诊地点比较因肺炎或鼻窦炎就诊的儿童开具阿片类药物和皮质类固醇处方的频率。
我们评估了2016年南卡罗来纳州医疗补助计划中5至18岁患有肺炎或鼻窦炎儿童的索赔数据。就诊地点与以下3种之一相关：急诊科（ED）、紧急护理或门诊环境。
31838名儿童符合纳入标准。肺炎就诊与急诊科开具阿片类药物处方的关联度（542例中有34例[6.3%]）高于门诊环境（1590例中有24例[1.5%]；P≤.0001），且与急诊科开具类固醇处方的关联度（542例中有106例[19.6%]）高于门诊环境（1590例中有196例[12.3%]；P≤.0001）。鼻窦炎就诊与急诊科开具阿片类药物处方的关联度（2705例中有202例[7.5%]）高于门诊环境（26866例中有568例[2.1%]；P≤.0001），且与急诊科开具类固醇处方的关联度（2705例中有510例[18.9%]）高于门诊环境（26866例中有1922例[7.2%]；P≤.0001）。在肺炎患儿的逻辑回归分析中，急诊科环境与接受阿片类药物（调整后的优势比[aOR]为4.69）或类固醇（aOR为1.67）的几率增加相关。同样，与门诊相比，鼻窦炎患者在急诊科更有可能被开具阿片类药物（aOR为4.02）或类固醇（aOR为3.05）。
与门诊环境相比，学龄儿童因肺炎或鼻窦炎在急诊科接受阿片类药物和类固醇处方的频率更高。
