Shifting practice in pediatric prescription opioid use in the emergency department for fractures

Objectives: Judicious opioid use is important for balancing patient comfort and safety. Although opioid use is well studied in adult populations, pediatric opioid prescription practices are less understood and there are very few guidelines regarding its usage. The purpose of this study was to investigate pediatric opioid prescription trends by emergency medicine physicians over the last ten years, including assessing proxies for the adequacy of pain control and risk of any opioid-related adverse events including overdose.Methods: A retrospective analysis was performed of all patients age 0 to 18 who presented to an urban county hospital emergency department (ED) between 2007 and 2017 for acute fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, adverse events, and secondary opioid prescrip-tions. Opioid prescription quantities were assessed in morphine equivalents (Meqs).Results: Out of 4713 patients diagnosed with acute fracture, opioid prescriptions from the ED were given to 1772 patients (37.6%), with a mean quantity of 107.0 Meqs (SD = 69.1). Over the ten-year period studied, prescription rates declined from 54.8% in 2007 to 13.6% in 2017. Although 201 (4.3%) fracture patients had a second fracture -related ED visit, only 27 visits (0.57%) were for inadequate pain control, with no significant differences in year-to-year analysis. During the ten-year study period, there were zero opioid overdoses reported among pediatric frac-ture patients.Conclusions: A major shift has occurred in the last ten years, as emergency medicine physicians now favor non-opioid pain management regimens over opioids for the majority of pediatric fracture patients. There was no in-crease in the rate of inadequate pain control requiring a return to the ED, even as opioid prescription rates de-clined during the study period.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study investigated the trends in pediatric opioid prescriptions by emergency medicine physicians over the last ten years, assessing the adequacy of pain control and the risk of opioid-related adverse events. The findings showed a significant shift towards non-opioid pain management regimens for pediatric fracture patients, as the prescription rates declined over the study period without an increase in the rate of inadequate pain control requiring a return to the emergency department.