Barq Rabab M, Ourshalimian Shadassa, Houshmand Laura, Keane Olivia A, Kim Eugene, Kelley-Quon Lorraine I
Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States; Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St #514, Los Angeles, CA 90033, United States.
Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States.
J Pediatr Surg. 2025 Feb;60(2):162007. doi: 10.1016/j.jpedsurg.2024.162007. Epub 2024 Oct 30.
Prescription drug monitoring programs (PDMPs) are state-run databases that track controlled substances to reduce substance use and diversion. The accuracy of PDMPs for adolescents who receive postoperative opioid prescriptions is unknown.
This prospective cohort study was conducted at a free-standing tertiary children's hospital from 2019 to 2020. Adolescents 13-20 y undergoing elective surgery commonly associated with an opioid prescription at discharge were enrolled. Prescription opioid fills and refills were measured through five data sources: (1) Electronic Medical Record (EMR) prescription orders (2) postoperative clinic notes, (3) California's PDMP and (4) adolescent and (5) parent surveys. UpSet plots were used to visualize and quantify data overlap between sources.
The majority of the 55 adolescents enrolled were Hispanic/Latino (52.7%), female (54.5%), and underwent posterior spinal fusion (41.8%). Of 42 adolescents with an opioid prescription in the EMR, the greatest overlap in data sources occurred between the EMR and PDMP (92.9%) with only 19% of adolescents having their opioid prescription fill captured in all five data sources. Two patients (3.6%) who did not receive an opioid prescription based on EMR or survey data were identified in the PDMP. Survey data indicated that eight adolescents (19.0%) refilled their opioid prescription. However, the PDMP only captured four (9.5%) refills.
Discrepancies exist among EMR, PDMP, and survey documentation of prescription opioid dispensing and refills for adolescents undergoing surgery. These findings highlight the need to capture multiple data sources when tracking prescription opioid dispensing. Additionally, there is opportunity for improved accuracy within prescription drug monitoring programs.
Prospective Cohort Study.
Level 4.
处方药监测计划（PDMPs）是由各州运营的数据库，用于追踪管制药品，以减少药物使用和滥用。对于接受术后阿片类药物处方的青少年而言，PDMPs的准确性尚不清楚。
这项前瞻性队列研究于2019年至2020年在一家独立的三级儿童医院进行。纳入了13至20岁接受择期手术的青少年，这些手术通常在出院时会开具阿片类药物处方。通过五个数据源来测量处方阿片类药物的配药和再配药情况：（1）电子病历（EMR）处方订单，（2）术后门诊记录，（3）加利福尼亚州的PDMP，以及（4）青少年和（5）家长调查问卷。使用UpSet图来可视化和量化各数据源之间的数据重叠情况。
纳入的55名青少年中，大多数是西班牙裔/拉丁裔（52.7%）、女性（54.5%），并接受了后路脊柱融合术（41.8%）。在电子病历中有阿片类药物处方的42名青少年中，数据源之间最大的数据重叠发生在电子病历和PDMP之间（92.9%），只有19%的青少年在所有五个数据源中都有阿片类药物配药记录。在PDMP中发现了两名患者（3.6%），他们根据电子病历或调查数据未接受阿片类药物处方。调查数据显示，有八名青少年（19.0%）再次开具了阿片类药物处方。然而，PDMP仅记录到四次（9.5%）再配药情况。
对于接受手术的青少年，电子病历、PDMP和处方阿片类药物配药及再配药的调查记录之间存在差异。这些发现凸显了在追踪处方阿片类药物配药时收集多个数据源的必要性。此外，处方药监测计划在准确性方面还有提升空间。
前瞻性队列研究。
4级。
