(366) Opioid Prescription Practices in the Setting of Pediatric Fractures

Abstract

Opioids are frequently prescribed to children with fractures. Although much research has been done surrounding the use of opioids in adult populations, use of opioids among children is much less understood. The purpose of this study was to investigate pediatric opioid prescription trends over the last ten years, and to compare prescription practices between doctors of different specialties. We performed a retrospective analysis of all patients age 0-18 who presented to an urban ED between 2007-2017 for fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, follow-up appointment specialty, and opioid prescriptions from the first follow-up visit. Opioid prescription quantities were assessed in morphine equivalents (MEs). From pilot data of 1,387 patients with fractures, 488 patients (35.2%) received an opioid medication in the ED. Morphine (202, 14.6%) and oxycodone (191, 13.7%) were the most common opioids give in the ED setting though oral hydrocodone and codeine, and IV fentanyl and hydrocodone were also used. Opioid prescriptions from the ED were given to 491 patients (35.4%), with a mean quantity of 111.7 MEs (SD=74.4). 1,059 patients attended a follow-up appointment. 47 of the 844 (6.7%) patients who followed-up with orthopedics, and 14 of the 103 (13.5%) who followed up with plastics received opioid prescriptions. The mean quantity of opioid prescribed at the first follow-up visit was 256.1 MEs (SD=162.9). Preliminary data suggests that larger quantities of opioids are given at follow-up visits than are given in the ED. For pediatric fractures, plastic surgeons prescribe opioids twice as frequently as orthopedic surgeons. The next step for this research to draw comparisons between patients of different age groups and different fracture types.