The US opioid crisis is negatively affecting children, and the rate of hospitalization and pediatric intensive care unit (PICU) admission for pediatric opioid ingestions is increasing, according to a study published in Pediatrics.
Jason M. Kane, MD, MS, FAAP, FCCM, from the Sections of Pediatric Critical Care and the Center for Healthcare Delivery Science and Innovation at the University of Chicago Medicine Comer Children’s Hospital, and colleagues, conducted a retrospective cohort study of the Pediatric Health Information System to identify hospitalizations for opioid ingestions from 2004 to 2015. All inpatient and observation encounters of children aged 1 to 17 years were included from 31 hospitals that provided continuous data during this period. Admission to the PICU and the use of naloxone, vasopressors, and ventilation were assessed by using billing data.
The primary outcome measure was the rate of PICU admission for opioid ingestion per 10,000 PICU admissions during the study period. Secondary outcomes included in-hospital mortality, total and PICU-associated costs and length of stay, and the use of vasopressors, naloxone, and mechanical ventilation.
Of 4,175,624 hospital admissions to 31 different children’s hospitals, 3,647 (0.09%) patients were admitted for opioid-related conditions, and 1,564 of this group were hospitalized (43%) and required PICU care. Opioid ingestions accounted for 31.2 per 10,000 PICU admissions. The rate of PICU admission for opioid-related hospitalization increased significantly, from 24.9 to 35.9 per 10,000 PICU admissions, with a peak of 36.6 per 10,000 PICU admissions in 2014. Overall, 37% of PICU admissions required mechanical ventilator support, and this decreased over time. Of the PICU admissions, 20% required vasopressors, and this also decreased over time.
The overall mortality was 1.6%, with deaths decreasing from 2.8% in the 2004 to 2007 epoch to 1.3% in the 2012 to 2015 epoch. In the 1- to 5-year-old age group, the average mortality was 1.4%, with a significant decrease over time.
“Current efforts to reduce prescription opioid use in adults have not curtailed the incidence of pediatric opioid ingestion, and additional efforts are needed to reduce preventable opioid exposure in children,” the authors concluded.
- Kane JM, Colvin JD, Bartlett AH, Hall M. Opioid-related critical care resource use in US children’s hospitals. Pediatrics. 2018 Mar 5. doi: 10.1542/peds.2017-3335. [Epub ahead of print]