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

1. Previously reported ethnic differences in opioid prescribing at discharge in the emergency department (ED) for pediatric long bone fractures in 2012 became non-significant by 2019.

2. Overall opioid prescribing at discharge in the ED declined from 27% in 2012 to 5% in 2019.

Evidence Rating Level: 2 (Good)

Study Rundown:

Prior research has described ethnic disparities in the frequency of opioid prescriptions for children after long bone fractures in the emergency department (ED). This study evaluated changes in opioid prescription based on ethnicity in children over time. Across 42,803 pediatric ED visits for long bone fractures, 15% of children received an opioid prescription, with non-Hispanic white children receiving the highest percentage of prescriptions (20%), even after controlling for reported pain and injury severity. Over time, the overall rate of opioid prescriptions decreased from 27% to 5%, with decreases across all ethnicity groups. From 2012 to 2019, the previously significant differences in prescription frequency across ethnic groups became non-significant. This study indicates that prescribing practices have changed in recent years, although which factors led to the overall decline in prescribing within and across groups are not clear.

Click to read the study in PEDIATRICS

In-Depth [retrospective cohort]:

This retrospective cross-sectional study included 42,803 pediatric Emergency Department visits from 4 centers across the United States through the Pediatric Emergency Care Applied Research Network (PECARN) Registry. Children aged 4-18 years who presented with a long bone (defined as clavicle, humerus, ulna, radius, femur, tibia, and fibula) fracture between 2012-2019 were included in the analysis. Race and ethnicity were defined as non-Hispanic white, non-Hispanic Black, Hispanic, and other. In total, 15% of children received an opioid prescription at discharge, which varied by race/ethnicity, with non-Hispanic white children receiving the highest frequency of prescriptions (20%), followed by Hispanic (13%), and then non-Hispanic Black (10%). Opioid prescription frequency decreased over time, from 27% in 2012 compared to 5% in 2019 (p<0.001) overall, with decreases reported in all race/ethnicity groups. There were no significant differences in prescribing frequency across ethnic groups (aOR 0.93, 95% CI 0.60-1.42).

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