Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures

Area of Science:

• Pediatric Emergency Medicine
• Pain Management
• Pharmacology

Background:

• Opioid prescriptions are common for pediatric fractures.
• Variability in prescribing practices exists.
• Understanding this variability is crucial for safe pain management.

Purpose of the Study:

• To measure the variability in discharge opioid prescription rates for children with long-bone fractures treated in emergency departments (EDs).
• To identify patient and injury characteristics associated with opioid prescribing.
• To explore potential for optimizing opioid prescribing guidelines.

Main Methods:

• Retrospective cohort study of pediatric ED visits in 2015.
• Analysis of electronic health record data from four pediatric EDs.
• Multivariable logistic regression to identify factors associated with opioid prescription.

Main Results:

• 15% of 5,916 children with long-bone fractures received an opioid prescription at discharge.
• Significant variation in prescribing rates was observed between the four EDs (8.2% to 23.8%).
• Older age, white non-Hispanic ethnicity, private insurance, fracture reduction, and severe pain were associated with increased opioid prescribing.

Conclusions:

• Discharge opioid prescribing for pediatric long-bone fractures shows wide variability by ED site.
• Patient and injury factors did not fully explain the observed prescribing disparities.
• Opioid prescribing practices may be modifiable, but evidence for optimal regimens is lacking.