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Study Suggests Increase in Adverse Effects Due to Use of Opioids in Hospitalized Children

9/15/2017

Study abstract to be presented at American Academy of Pediatrics 2017 National Conference & Exhibition in Chicago reveals urgent need for safer pain medications for children.

CHICAGO –  The number of hospitalized infants, children and teens who experienced adverse reactions to opioid painkillers increased by more than half between 2003 and 2012, according to research being presented during the American Academy of Pediatrics 2017 National Conference.

The study abstract, "Adverse Effects from Opioid Use in Hospitalized Children in the United States: a 9-year trend from 2003 to 2012," will be presented on Friday, Sept. 15.  Researchers examined 2003, 2006, 2009 and 2012 data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) to analyze hospital stays of children aged 1 month to 17 years.

"We found opioid-related problems were relatively common in hospitalized children," said abstract author Jessica Barreto, MD. Overall, opioid-related problems were documented in 16.6 children per 10,000 discharges. The prevalence significantly increased over the years from 13.3 per 10,000 discharges in 2003, she said, to 20.8 per 10,000 discharges in 2012.

The most significant finding was that the frequency of opioid withdrawal has more than doubled since 2003, said Barreto, a third-year pediatrics resident at Nicklaus Children's Hospital in Miami. Adverse effects from opioids were highest in white children in every year examined, suggesting race may play a role in which children are prescribed opioids to treat pain. 

In addition to opioid withdrawal, which affected 3.1 percent of the hospitalized children, other adverse effects included constipation (12.5 percent), altered mental status (10.5 percent), opioid withdrawal (3.1 percent), urinary retention (2.3 percent), cardiac arrest (1 percent) and anaphylaxis (0.75 percent).

"For the past two decades, doctors have been increasingly recognizing and treating pain in children. Unfortunately, the efforts to improve pain management in children have led to a significant rise in the use of opioids both within hospitals as well as in the outpatient setting," Barreto said.

"While these medications are valuable in providing pain relief, there are various developmental factors that place children at higher risk of toxicity," she said, "Further studies on the safety and efficacy of opioid use in children and alternate pain medications with less toxicity and addiction potential are urgently needed," she said. "In the meantime, judicious use of opioid medications for the treatment of pain and monitoring for their side effects is crucial."

Dr. Barreto will present the abstract on Friday, Sept. 15, between 4:30 p.m. and 5:45 p.m. at Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Pritzker School of Law's Thorne Auditorium, 375 East Chicago Ave. To request an interview with Dr. Barreto, contact her at jessica.barretoguacaneme@mch.com or (305) 666-6511.

In addition, highlighted abstract authors will be available to the media during an informal Media Meet-and-Greet session Saturday, Sept. 16, from 12:15-1:15 p.m. CT in room Grant Park CD of the Hyatt Regency McCormick Place (Press Office). 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.

 

Abstract Title: Adverse Effects from Opioid Use in Hospitalized Children in the United States: a 9-year trend from 2003 to 2012

Background Multiple studies have reported opioids to be the leading contributors of adverse drug events in hospitalized children. Objective To evaluate the prevalence of adverse effects from opioid use in hospitalized children in the United States during the years 2003, 2006, 2009 and 2012 and analyze the trend. Methods A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for the years 2003, 2006, 2009 and 2012 was performed. Children aged 1 month – 17 years with a diagnosis of adverse effects from opioid use (ICD-9-CM E935.0, E935.1, E935.2, E850.0, E850.1, E850.2) were included for analysis. Chi Square test was used to compare various adverse events in this cohort with rest of the discharges. Sample weighting was employed to produce national estimates. Results A total of 13,853 cases of adverse effects of opioid use were identified during the study years with an overall prevalence of 16.6 per 10,000 discharges. The prevalence has increased progressively from 13.3/10,000 discharges in 2003 to 20.8/10,000 discharges in 2012 (p < 0.001; Chi Square Analysis for Linear Trend, Fig 1). Median hospital charges have also continued to rise and in 2012 reached USD 30,840 (IQR: 13,085 – 81,262). Median length of stay has remained unchanged at 4 days (IQR: 2-7). The adverse events were lowest in infants and highest in the adolescent group (20.1 to 30.2 per 10,000; p < 0.01 for trend analysis). Adverse events were highest in white children in every year evaluated (17.3 to 23.4 per 10,000). There was no gender predilection. Some commonly associated adverse events with opioid use in 2012 were, opioid withdrawal (3.1%, OR 30.3, 95%CI 25.2-36.4); constipation (12.5%, OR 22.5, 95%CI 20.5-24.8); anaphylaxis (0.75%, OR 12.8, 95%CI 8.9-18.4); urinary retention (2.3%, OR 16.0, 95%CI 13.0-19.8); altered mental status (10.5%, OR 8.3, 95%CI 7.5-9.2); and cardiac arrest (1.0%, OR 4.4, 95%CI 3.2-6.1). Of note, the frequency of opioid withdrawal has more than doubled since 2003 (1.3%, OR 29.1, 95%CI 20.9-40.5). In 2012, 38.7% (OR 2.6, 95%CI 2.4-2.7) were post-surgical patients. Endotracheal intubation was done in 6.0% of patients (OR 4.7, 95%CI 4.2-5.4). The mortality rate in 2012 was 0.68% (OR 2.1, 95%CI 1.4-3.0). Conclusions The adverse effects from opioid use are relatively common in hospitalized children and their prevalence has significantly increased over the years. This study provides an indirect evidence of increasing trend of opioid use in hospitalized children in the US.