title: Comparative Safety of Morphine Delivered via Intravenous Route vs. Patient-Controlled Analgesia Device for Pediatric Inpatients.
abstract: Although patient-controlled analgesia (PCA) is an effective pain control modality, there is a lack of large studies on PCA safety in pediatric patients.
  
  
  
  This study compared the delivery of morphine either via intravenous route (morphine IV) or via PCA device (morphine PCA) on risk of cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) using a large administrative database.
  
  
  
  We assembled a retrospective cohort of pediatric inpatients between five and 21 years old in 42 children's hospitals between 2007 and 2011 from the Pediatric Health Information System database. After propensity score matching, we created matched cohorts of morphine PCA and morphine IV patients, in both surgical and nonsurgical samples, who were similar on demographic, clinical, and hospital-level factors. We examined if PCA administration was associated with greater likelihood of CPR or MV up to two days after drug administration.
  
  
  
  Surgical and nonsurgical patients administered morphine PCA generally had lower odds of having MV on the baseline day and up to two days after PCA exposure, although these estimates were not statistically significant. Similarly, PCA exposure was associated with about 20%-44% lower odds of same day CPR in both surgical and nonsurgical patients, with a slightly greater reduction in the odds of CPR in the surgical patients.
  
  
  
  In this large pediatric inpatient population, morphine administered via PCA device for surgical and nonsurgical pain was not associated with an increased risk of receiving CPR or MV, and was associated with slightly better safety outcomes than intravenous morphine.
authors.affiliation: Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Faerber
authors.affiliation: Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Zhong
authors.affiliation: Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.affiliation: The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Avi
authors.initials: A
authors.lastname: Baehr
authors.affiliation: Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Lynne G
authors.initials: LG
authors.lastname: Maxwell
authors.affiliation: Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Francis Wickham
authors.initials: FW
authors.lastname: Kraemer
authors.affiliation: Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: feudtner@email.chop.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D015984:Causality; D002648:Child; D002675:Child, Preschool; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000706:statistics & numerical data*; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects; D015995:Prevalence; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012646:Self Administration / Q000295:instrumentation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Pain management; comparative effectiveness; inpatients; morphine; patient-controlled analgesia; pediatric; research