M. A. Chaudhary1, A. J. Schoenfeld1, A. Ranjit1, R. Scully1, R. Chowdhury1, S. Nitzschke1,3, T. Koehlmoos2, A. H. Haider1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Uniformed Services University Of The Health Sciences,Bethesda, MD, USA 3Brigham And Women’s Hospital,Trauma, Burn And Surgical Critical Care,Boston, MA, USA
Introduction: The prevalence of pain at hospital discharge among patients with traumatic injury is as high as 97%; 59% of whom experience moderate to severe pain. Inadequate pain control after trauma is associated with poor quality of life, delayed return to work and chronic pain syndrome. Opioids are considered the first line treatment for acute pain and treatment with opioids is associated with reduced likelihood of developing chronic pain. The Objectives of this study were to describe the prevalence of opioid prescription among trauma patients at hospital discharge and determine the predictors for the receipt of opioids for pain management.
Methods: The Military Health System Data Repository (MDR) was queried for TRICARE healthcare claims data from 2006 to 2014. Opioid-naive patients (18-64) admitted for traumatic injury were included in the study. Patients who died during index hospitalization or were transferred to another healthcare facility were excluded. The outcome variable was defined as at least one prescription of opioids at discharge. Logistic regression models, adjusted for patient demographic and clinical characteristics, and environment of care were used to determine predictors of opioid prescription.
Results:Among the 27,114 patients included in the study, 14,017 (51.7%) received an opioid prescription at discharge. In risk-adjusted models, older adults (45-64y vs. 18-24y: OR= 1.38, 95% CI: 1.25-1.54), married patients (OR: 1.23, 95% CI: 1.16-1.30) and patients with higher Injury Severity Score (>9 vs. <9; OR: 1.24, 95% CI: 1.17-1.32) were associated with higher likelihood of opioid prescription. Males (OR: 0.77, CI: 0.71-0.83), Asians vs. non-Hispanic Whites (OR: 0.84, CI: 0.75-0.95), anxiety diagnosis (OR: 0.80, CI: 0.71-0.89) and traumatic brain injury (AIS head>3) (OR: 0.61, CI: 0.55-0.66) were associated with decreased likelihood of opioid prescription. Pre-existing comorbidities and presence of depression were not significant predictors of opioid prescription.
Conclusion:The rate of opioid prescription in trauma patients was 51.7%. Compared to the reported prevalence of pain among such patients at discharge, the rate of use of opioid for pain control at discharge seems low. Identifying factors associated with receipt of opioids at discharge, might help promote appropriate prescribing patterns among trauma patients thereby reducing incidence of chronic pain in this population.