Variation of opioid use in pediatric inpatients across hospitals in the U.S.
BACKGROUND
Appropriate use of opioids is essential to manage moderate-to-severe pain in children safely and effectively, yet published guidance regarding opioid treatment for pediatric patients is limited, potentially resulting in excessive variation in opioid use in pediatric patients across hospitals in the U.S.


OBJECTIVE
The aim was to evaluate hospital variation in opioid use in pediatric inpatients.


METHODS
Using data from the Pediatric Health Information System and the Premier Perspective Database regarding all pediatric inpatients in 626 hospitals, we examined hospital variation in opioid use and the length of opioid use, adjusting for patient demographic and clinical characteristics and for hospital type (children's vs. general) and hospital patient volume, using multilevel generalized linear regression modeling.


RESULTS
Overall, 41.2% of all pediatric hospitalizations were exposed to opioids. Among the exposed patients, the mean length of exposure was 4.6 days. Exposure proportion and exposure length varied substantially across hospitals, even after accounting for patient demographic and clinical characteristics, hospital type and hospital patient volume, especially among terminal hospitalizations. For patients discharged alive vs. died, the adjusted exposure percentage for each hospital ranged from 0.7% to 99.1% (interquartile range [IQR]: 35.3%-59.9%) vs. 0.1% to 100.0% (IQR: 29.2%-66.2%), respectively, and the adjusted exposure length ranged from 1.0 to 8.4 days (IQR: 2.2-2.7 days) vs. 0.9 to 35.2 days (IQR: 4.0-7.4 days).


CONCLUSIONS
The substantial hospital-level variation in opioid use in pediatric inpatients suggests room for improvement in clinical practice.
Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
James
J
Womer
Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Wenjun
W
Zhong
Anesthesiology and Critical Care Medicine and Pain Management Service, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
F Wickham
FW
Kraemer
Anesthesiology and Critical Care Medicine and Pain Management Service, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Lynne G
LG
Maxwell
Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Elizabeth A
EA
Ely
Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Jennifer A
JA
Faerber
Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Dingwei
D
Dai
Pediatric Advanced Care Team and Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: feudtner@email.chop.edu.
Chris
C
Feudtner
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
D000701:Analgesics, Opioid
Opioid analgesics; inpatient; pain management; palliative medicine; pediatric; physician's practice patterns; prevalence