Abstract
Objective: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. Methods: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11–21 from 2008–2017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). Results: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 visits nationwide. Overall, patients with a score of 10 were 1.35 times more likely to receive an opioid than patients scoring a 9, 41.7% (CI95 39.7–43.8%) and 31.0% (CI95 28.8–33.3%), respectively. Opioid use was significantly different between traditional pain score cutoffs of mild (1–3) and moderate pain (4–6), where scores of 4 were 1.76 times more likely to receive an opioid than scores of 3, 15.5% (CI95 13.7–17.3%) and 8.8% (CI95 7.1–10.6%), respectively. Scores of 7 were 1.33 times more likely to receive opioids than scores of 6, 24.7% (CI95 23.0–26.3%) and 18.5% (CI95 16.9–20.0%), respectively. Fractures had the highest likelihood of receiving an opioid, as 49.2% of adolescents with a fracture received an opioid (CI95 46.4–51.9%). Within this subgroup, only adolescents reporting a fracture pain score of 10 had significantly higher opioid use than adjacent pain scores, where fracture patients scoring a 10 were 1.4 times more likely to use opioids than those scoring 9, 82.2% (CI95 76.1–88.4%) and 59.8% (CI95 49.0–70.5%), respectively. Conclusions: While some guidelines in the adult population have revised cut-offs and groupings of the traditional tiers on a 0–10 point pain scale, the adolescent population may also require further examination to potentially warrant a similar adjustment.
Highlights
Acute pain is one of the primary reasons for visiting a US emergency department (ED) [1] and over 20% of adolescents visit a US ED each year [2]
Reported rates of opioid use versus independent pain scores showed a significant increase in opioid use rates from 3 to 4 and 6 to 7, which is consistent with earlier National Hospital Ambulatory Medical Care Survey (NHAMCS) studies that examined pain intensity as mild, moderate, and severe pain
Our results showed that certain pain scores within a range had similar opioid prescribing rates, suggesting that prescribers are less concerned with the precise score reported and instead are more focused on categorizing the degree of severity of patient pain
Summary
While some opioid guidelines exist [3,4,5,6], healthcare providers must constantly weigh in the risks and benefits of using an opioid. These methods often rely on assessing factors such as diagnosis, age, treatment goals, and pain severity before prescribing an opioid [7]. One factor of interest is the use of patient-reported pain scores to assess pain severity and how that relates to the decision to prescribe an opioid. Self-reported pain severity is a major factor used by clinicians to assess pain. The translation of these scores to treatment with analgesia are not as closely correlated as one would expect There is often a high degree of interpatient variability and reported pain can vary with factors such as age, sex, and ethnicity [9,10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
