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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. The rate of pediatric intensive care unit (PICU) admissions attributable to opioid ingestions has significantly increased over the past decade.

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2. While the cost of PICU admission attributable to opioid ingestion has significantly decreased over the past decade, the use of mechanical ventilation and vasopressors in patients from such admissions has significantly increased.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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Ingestion of prescription medications is a major cause of morbidity in the pediatric population, and the occurrence of such events has increased significantly within the past 2 decades. Between 1997 and 2012, the incidence of hospital admission attributable to opioid poisoning nearly doubled in pediatric patients. Adult literature has shown an increase in adult intensive care use and mortality related to opioid overdose. No existing studies have explored this question in pediatric patients. In this retrospective cohort study, researchers evaluated the trend in PICU admissions related to opioid ingestion between 2004-2015 as well as secondary admission features including mortality rate, cost, use of vasopressors and mechanical ventilation. Their data showed a significant increase in the rate of PICU admissions attributable to opioid ingestion per 10 000 PICU admissions. Additionally, their data showed a significant decrease in median total cost, use of vasopressors, and mechanical ventilation overtime for PICU admissions attributable to opioid ingestion. Limitations of the study included generalizability limited to tertiary children’s hospitals and dependence on medical billing codes. The increased rate in PICU hospitalization attributable to opioid ingestion suggests a need for more research on interventions to reduce preventable opioid exposure in children.

In-Depth [retrospective cohort study]:

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In this study, researchers analyzed data from the Pediatric Health Information System (PHIS) database pertaining to inpatient and outpatient encounters attributable to prescription or illicit opioid usage. Data was analyzed for encounters with children ages 1 to 17 years between January 1, 2004 and September 30, 2015 from 31 hospitals. The primary outcome was the rate of PICU admission attributable to opioid ingestion per 10 000 PICU admissions. The rate of PICU admission attributable to opioid ingestion increased significantly from 24.9 to 35.9 per 10 0000 PICU admissions (P < 0.001) between 2004-2015. However, the relative percentage of pediatric patients with opioid-related hospitalizations requiring PICU admission was not significantly different. Between 2004-2007, 2008-2011, 2012-2015, there were 250 (31.4%), 382 (28.4%) and 415 (27.6%) PICU admissions attributable to opioid ingestion, respectively (P = 0.086). Significant secondary outcomes related to PICU admissions attributable to opioid ingestions included in-hospital mortality, PICU-associated costs, and usage of vasopressors and mechanical ventilation. The average mortality was 1.4% with a significant decrease over time (P<0.001). Between 2004-2007, 2008-2011 and 2012-2015, the number of deaths were 58 (1.6%), 22 (2.8%), and 17 (1.3%), respectively. The median cost in dollars (adjusted for dollar value in 2015) showed a significant decline over time, with values decreasing in 2004-2007, 2008-2011 and 2012-2015 from $6254, $4799 and $4552 (P < 0.001), respectively. For opioid-attributed PICU admissions, the use of vasopressors (P = 0.001) and mechanical ventilation (P < 0.001) increased significantly over time.

References:

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Burghardt LC, Ayers JW, Brownstein JS, Bronstein AC, Ewald MB, Bourgeois FT. Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics. 2013; 132 (1): 18-27.

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Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997-2012. JAMA Pediatr. 2016; 170 (12): 1195-1201.

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