title: Pediatric exposure to opioid and sedation medications during terminal hospitalizations in the United States, 2007-2011.
abstract: OBJECTIVE
  To describe the use of opioids and sedatives to pediatric patients dying in the hospital in the 2 weeks preceding death.
  
  
  METHODS
  We conducted a retrospective study on opioid and sedation medication exposure among children who die in hospitals in the US by using large administrative data sources. We described patterns of exposure to these medications for deceased inpatients (<21 years of age) between 2007 and 2011 (n = 37,459) and factors associated with the exposure. Multivariable logistic regression models were used to estimate the ORs.
  
  
  RESULTS
  Overall, 74% patients were exposed to opioids or sedatives in the 14 days before death. Among patients with 6 or more hospital days before death, the daily exposure rate ranged from 73% (the sixth day before death) to 89% (the day of death). The most commonly used medications were fentanyl (52%), midazolam (44%), and morphine (40%). Older age (ORs 1.6-3.7), black race (ORs 0.8), longer hospital stay (ORs 6.6-9.3), receiving medical interventions (including mechanical ventilation, surgery, and stay in the intensive care unit, ORs 1.7-2.6), having comorbidities (ORs 1.7-2.4), and being hospitalized in children's hospitals (ORs 4.0-4.5) were associated with exposure of opioid and sedation medication on adjusted analysis.
  
  
  CONCLUSIONS
  Although most pediatric patients terminally hospitalized are exposed to opioid and sedation medication, some patients do not receive such medications before death. Given that patient and hospital characteristics were associated with opioid/sedative exposure, these findings suggest areas of potential quality improvement and further research.
authors.affiliation: Kentucky Children's Hospital, Lexington, KY.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Ragsdale
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Zhong
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Wynne
authors.initials: W
authors.lastname: Morrison
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Munson
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Tammy I
authors.initials: TI
authors.lastname: Kang
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: feudtner@email.chop.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000701:Analgesics, Opioid / Q000494:pharmacology*; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives