Variation of Opioid Use in Pediatric Inpatients Across Hospitals in the U.S
| Autor: | James W. Womer, Wenjun Zhong, Lynne G. Maxwell, Chris Feudtner, Jennifer Faerber, Dingwei Dai, Elizabeth Ely, F. Wickham Kraemer |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Context (language use) Discharged alive Appropriate use Pediatrics Young Adult Interquartile range Humans Medicine Hospital patients Child General Nursing Inpatients business.industry Opioid use Infant Hospitals Pediatric United States Analgesics Opioid Hospitalization Anesthesiology and Pain Medicine Hospital treatment Opioid Child Preschool Emergency medicine Female Neurology (clinical) business medicine.drug |
| Zdroj: | Journal of Pain and Symptom Management. 48:903-914 |
| ISSN: | 0885-3924 |
| Popis: | Context Appropriate use of opioids is essential to manage moderate-to-severe pain in children safely and effectively, yet published guidance regarding opioid treatment for pediatric patients is limited, potentially resulting in excessive variation in opioid use in pediatric patients across hospitals in the U.S. Objectives The aim was to evaluate hospital variation in opioid use in pediatric inpatients. Methods Using data from the Pediatric Health Information System and the Premier Perspective Database regarding all pediatric inpatients in 626 hospitals, we examined hospital variation in opioid use and the length of opioid use, adjusting for patient demographic and clinical characteristics and for hospital type (children's vs. general) and hospital patient volume, using multilevel generalized linear regression modeling. Results Overall, 41.2% of all pediatric hospitalizations were exposed to opioids. Among the exposed patients, the mean length of exposure was 4.6 days. Exposure proportion and exposure length varied substantially across hospitals, even after accounting for patient demographic and clinical characteristics, hospital type and hospital patient volume, especially among terminal hospitalizations. For patients discharged alive vs. died, the adjusted exposure percentage for each hospital ranged from 0.7% to 99.1% (interquartile range [IQR]: 35.3%–59.9%) vs. 0.1% to 100.0% (IQR: 29.2%–66.2%), respectively, and the adjusted exposure length ranged from 1.0 to 8.4 days (IQR: 2.2–2.7 days) vs. 0.9 to 35.2 days (IQR: 4.0–7.4 days). Conclusion The substantial hospital-level variation in opioid use in pediatric inpatients suggests room for improvement in clinical practice. |
| Databáze: | OpenAIRE |
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