GA4-89
A One Year Audit of Pediatric Opioid Prescribing Practices at a Tertiary Care Hospital for Burn Analgesia
Khan A, Parikh M, Williams T, Abrams R, Minhajuddin A, Kandil E, Ambardekar A
UT Southwestern Medical Center, Dallas, TX, United states
Introduction
Opioids are the primary analgesic used in burn injuries for adults, but little data has been collected demonstrating opioid practices in the pediatric burn population. The purpose of this study is to understand opioid patterns in pediatric burn patients at a tertiary referral burn center.
Methods
A single-site retrospective audit of hospital charts and discharge records for patients <18 years old admitted to a tertiary referral burn center from March 2016 to March 2017 was performed. Charts were reviewed for demographic data, admission history, and data related to opioid management during admission and discharge. Furthermore, data on the use of any adjuvant pain therapy was collected. Outpatient follow-up data was collected. All intraoperative data and opioids used for sedation were excluded. Primary outcomes were identifying opioid patterns for analgesia during admission, and use of adjuvant therapy. Secondary outcomes included total amount of opioid administered during admission and prescribed at discharge, outpatient follow-up and availability of anti-emetics and stool-softeners during admission.
Results
A total of 226 pediatric burn patients were audited, the median age was 2.8 years old (IQR: 1.4-6.8), the median weight was 13.9 kg (IQR: 11-24), the mean total burn surface area was 6.6% (SD ± 5.4) and the median length of stay was 1.0 days (IQR: 1.0-2.0). Of the 226 patients, 223 (98.7%) were administered an opioid during admission. Hydrocodone (96.0%) was the most common opioid administered, followed by morphine (88.1%) and fentanyl (0.5%). The most common opioid combination was intravenous morphine and oral hydromorphone (50.4%). The median total opioid amount administered during admission was 0.4 (IQR: 0.3-0.6) mg of oral morphine equivalents (OME) per kg per day. The median total opioid amount prescribed upon discharge was 2.7 (IQR: 0.3-5.1) mg of OME per kg. The most commonly prescribed discharge opioid was oral hydrocodone (95.4%). Adjuvant pain therapy during admission was used in 112 patients (49.6%). During admission, anti-emetics were ordered for 86 patients (38.1%), and stool-softeners were ordered for 72 patients (31.9%).
Discussion
The data demonstrates a consistent pattern of opioid administration during admission and opioid prescription at discharge. With such high amounts of opioids at discharge, we must ask if there are safer non-opioid options for pediatric burn analgesia. Furthermore, the use of adjuvant therapy was inconsistent and underutilized, highlighting an area for improvement and an opportunity to minimize opioid use in the pediatric burn population. Based upon the frequent use of opioids, the availability of anti-emetics and stool-softeners can be improved to minimize the common side-effects of opioids.
Conclusion
This study provides novel insight into the opioid practices at a major tertiary burn center for pediatric patients. It emphasizes the need to expand beyond opioids for burn injury analgesia and identifies area for safer opioid practices.
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