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Variation of opioid use in pediatric inpatients across hospitals in the U.S
James Womer1, Wenjun Zhong1, F Wickham Kraemer2
1Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Opioid use in pediatric inpatients varies significantly across U.S. hospitals. This study highlights the need for standardized clinical practices in pediatric pain management to ensure appropriate opioid prescribing.
Area of Science:
- Pediatric pharmacology
- Health services research
- Clinical practice variation
Background:
- Opioid analgesics are crucial for managing moderate-to-severe pain in children.
- Limited published guidance contributes to inconsistent opioid prescribing in pediatric care.
- Significant variation in pediatric opioid use exists across U.S. hospitals.
Purpose of the Study:
- To investigate and quantify hospital-level variations in opioid utilization among pediatric inpatients.
- To identify factors contributing to differential opioid prescribing patterns in pediatric populations.
Main Methods:
- Utilized data from 626 hospitals via the Pediatric Health Information System and Premier Perspective Database.
- Employed multilevel generalized linear regression to analyze hospital variation in opioid exposure and duration.
- Adjusted for patient demographics, clinical factors, hospital type, and patient volume.
Main Results:
- Opioids were administered in 41.2% of pediatric hospitalizations, with a mean exposure of 4.6 days.
- Substantial hospital variation in opioid exposure proportion and length was observed, even after statistical adjustments.
- Disparities in opioid use were particularly pronounced in terminal hospitalizations and varied widely between hospitals.
Conclusions:
- Significant hospital-level variation in pediatric inpatient opioid use indicates potential for optimizing clinical practices.
- Standardized guidelines and interventions may be necessary to reduce unwarranted variability in pediatric opioid prescribing.
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.
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