NM-308
A One Year Evaluation of Discharge Opioid Practices at a Tertiary Burn Hospital for One-Day Stay Pediatric Burn Patients
Khan A, Parikh M, Williams T, Abrams R, Minhajuddin A, Kandil E, Ambardekar A
UT Southwestern Medical Center, Dallas, Texas, USA
Introduction
Approximately a million children in the United States are annually affected by burn injuries. Unfortunately, opioid practices in the pediatric population for burn analgesia have been poorly studied in the literature. The purpose of this study is to understand discharge opioid prescribing patterns at a tertiary referral burn center for pediatric patients who were discharged after a one-day stay. Our goal is to identify areas to improve opioid use and increase patient safety.
Methods
A single-site retrospective review 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. Only patients discharged within one-day (<48 hours) were included. One-day discharge was defined as discharge by the end of day following admission. Charts were reviewed for demographic data, admission history, and data related to medication management during admission and discharge. Outpatient follow-up data was collected. Any intraoperative data was excluded. Primary outcomes were opioid prescription patterns at discharge, use of adjuvant therapy, and total amount of opioid administered during admission. Secondary outcomes included availability of anti-emetics and stool-softeners during admission.
Results
A total of 124 pediatric burn patients were audited, the median age was 2.8 years old (IQR: 1.3-6.0), the median weight was 13.9 kg (IQR: 11.1-21.0), the mean total burn surface area was 4.75% (SD ± 3.4) and the mean length of stay was 20.2 hours (SD ± 6.5). Of the 124 patients, 121 (97.6%) were administered an opioid during admission. Hydrocodone (78.2%) was the most common opioid administered, followed by morphine (77.4%), and fentanyl (4.0 %). The most common opioid combination was intravenous morphine and oral hydromorphone (48.4%). The median opioid amount administered during admission was 0.5 (IQR: 0.3-0.7) mg oral morphine equivalents (OME) per kg. The median opioid amount prescribed upon discharge was 2.66 (IQR: 0.0-4.9) mg OME per kg. Of the 92 patients (74.2%) prescribed opioids at discharge, the most commonly prescribed opioid was oral hydrocodone (94.6%). Adjuvant pain therapy during admission was used in 45 patients (36.3%). A one-week scheduled follow-up appointment was attended by 95 patients (76.6%), with 86 patients (90.5%) having their opioid prescription discontinued.
Discussion
The data demonstrates a consistent pattern of opioid administration during admission and opioid prescription at discharge. The difference between the amount of opioid administered during admission to the amount of opioid discharged suggests that pediatric patients are being over-prescribed opioids at discharge. Furthermore, the use of adjuvant therapy appears to be inconsistent and underutilized, thereby indicating an avenue to minimize and optimize opioid use in the pediatric burn population. The follow-up data suggests that a majority of the patients were not requiring opioids at follow-up, indicating a greater role for adjuvant medication on discharge.
Conclusion
This study emphasizes the need to expand beyond opioids for burn injury analgesia and identifies area for safer opioid practices.
Top
