Related Experiment Video
Updated: Dec 29, 2025
Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents
Published on: August 14, 2018
Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures
Amy L Drendel1, David C Brousseau1, T Charles Casper2
1Medical College of Wisconsin, Wisconsin.
Insights
Opioid prescribing for pediatric long-bone fractures varied significantly across emergency departments (EDs). Factors like age and insurance influenced prescriptions, suggesting potential for practice modification.
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.
Objective:
To measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture.
Design:
A retrospective cohort study of pediatric ED visits in 2015.
Setting:
Four pediatric EDs.
Subjects:
Children aged four to 18 years with a long-bone fracture discharged from the ED.
Methods:
A multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription.
Results:
There were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A = 8.2% (95% confidence interval [CI] = 6.9-9.7%), B = 12.1% (95% CI = 10.5-14.0%), C = 16.9% (95% CI = 15.2-18.8%), D = 23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing.
Conclusions:
For children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking.
More Related Videos
Related Concept Videos
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:02Prescription, Nonprescription and Orphan Drugs
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:25Analgesia and Pain Management
01:29Drug Dosing: Infants and Children