A. AlFarra1, N. B. Hebballi1, E. I. Garcia1, T. F. Huzar2, J. M. Cross2, K. Tsao1, L. T. Li1 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA 2McGovern Medical School at UTHealth,Department Of Surgery,Houston, TX, USA
Introduction: While opioids are prescribed to pediatric burn patients to manage pain, early introduction of pain medication may lead to long-term sequela of addiction. There is little data demonstrating the prescription and utilization of opioid in the pediatric burn population. We aimed to characterize the opioid prescribing and prescription filling patterns in the pediatric burn patients and identify predictors of opioid prescribing and filling patterns. We predicted that over 50% of inpatients were discharged with an opioid prescription and less than half of patients filled their prescription.
Methods: We conducted a retrospective medical record review of all inpatients (0 months-18 years) who were admitted with a burn diagnosis (ICD-10 T20.0 – T31.0) at a single institution from November 1, 2018 to May 31, 2019. We collected patient demographics in addition to inpatient and discharge medications. A corresponding review of the Texas Prescription Monitoring Program (PMP Aware) was performed to compare the prescriptions prescribed by the physicians and the prescription filled by the patients. Multivariate analysis was performed to identify predictors of opioid prescription at discharge and predictors of opioid filling practice.
Results: Of 168 admitted pediatric burn patients, 138 (82%) patients were prescribed opioids at discharge. Of these, 120 (87%) of patients filled their prescription. 1% of patients had 1st degree burn as their most severe burn, 85% had 2nd degree, and 14% had 3rd degree burn. The median total body surface area burned was 3% (IQR 1.25-5). Patients with second degree burns and over 24 hour admission were associated with having a prescription for an opioid (see Table). We did not identify any factors that were associated with whether the patients filled the prescription. For 120 patients who filled their opioid prescriptions, the average daily morphine milligram equivalent (MME) prescribed at discharge was 6.74 MME, while the average inpatient opioid dose given during the last 24 hours was 3.88 MME for the same patient group.
Conclusion: We identified a high rate of opioid prescribing pattern among pediatric burn patients, and found that outpatient prescription MME was higher than inpatient MME use for some patients. We found that patients with a second degree burn admitted for more than a day were associated with getting an opioid prescription. More patients than hypothesized filled their prescription, and we were not able to identify any predictors for patients who did not fill their prescriptions. Further research is needed to determine avenues to reduce prescriptions of opioids at the time of discharge of pediatric patient.
