Article

Use of analgesic, anesthetic, and sedative medications during pediatric hospitalizations in the United States 2008.

MIE Resources, PO Box 532, Kingston, RI 02892. .
Anesthesia and analgesia (Impact Factor: 3.08). 05/2012; 115(5):1155-61. DOI: 10.1213/ANE.0b013e31825b6fb2
Source: PubMed

ABSTRACT The wide need for analgesia, anesthesia, and sedation in children and the lack of pediatric labeling leads to widespread off-label use of medications for pain and sedation in children. Any attempt to address the lack of labeling will require national estimates of the numbers of children using each medication, their ages, and other factors, to understand the overall use of these medications. We describe use of analgesics, anesthetics, and sedatives in pediatric inpatients by result of conducting a statistical analysis of medication data from >800,000 pediatric hospitalizations in the United States. The purpose was to provide national estimates for the percentage of hospitalized children receiving specific analgesics, anesthetics, and sedatives and their use by age group.
Data from the Premier Database, the largest hospital-based, service-level comparative database in the country, were used. We identified all uses of a given medication, selected the first use for each child, and calculated the prevalence of use of specific medications among hospitalized children in 2008 as the number of hospitalizations in which the drug was used per 100 hospitalizations. Dose and number of doses were not considered in these analyses.
The dataset contained records for 877,201 hospitalizations of children younger than 18 years of age at the time of admission. Thirty-three medications and an additional 11 combinations were administered in this population, including nonsteroidal antiinflammatory drugs, local and regional anesthetics, opioids, benzodiazepines, sedative-hypnotics, barbiturates, and others. The 10 most frequently administered analgesic, anesthetic, or sedative medications used in this population were acetaminophen (14.7%), lidocaine (11.0%), fentanyl (6.6%), ibuprofen (6.3%), morphine (6.2%), midazolam (4.5%), propofol (4.1%), lidocaine/prilocaine (2.5%), hydrocodone/acetaminophen (2.1%), and acetaminophen/codeine (2.0%). Use changed with age, and the direction of change (increases and decreases) and the type of change (linear, u-shaped, or other) appeared to be specific to each drug.
A variety of drug classes and individual medications were used to manage pain and sedation in hospitalized children. The variation in patterns of use reflects the heterogeneity of the dataset, comprising a wide range of ages and conditions in which analgesia, anesthesia, and sedation might be required. It was not possible to assess whether use of a specific medication was clinically appropriate, except to note use of medications in age subgroups without pediatric labeling.

0 Bookmarks
 · 
52 Views
  • BJA British Journal of Anaesthesia 05/2013; 110(5):843-844. · 4.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of genetic information to guide medication decisions holds great promise to improve therapeutic outcomes through increased efficacy and reduced adverse events. As in many areas of medicine, pediatric research and clinical implementation in pharmacogenetics lag behind corresponding adult discovery and clinical applications. In adults, genotype-guided clinical decision support for medications such as clopidogrel, warfarin and simvastatin are in use in some medical centers. However, research conducted in pediatric populations demonstrates that the models and practices developed in adults may be inaccurate in children, and some applications lack any pediatric research to guide clinical decisions. To account for additional factors introduced by developmental considerations in pediatric populations and provide pediatric patients with maximal benefit from genotype-guided therapy, the field will need to develop and employ creative solutions. In this article, we detail some concerns about research and clinical implementation of pharmacogenetics in pediatrics, and present potential mechanisms for addressing them.
    Personalized Medicine 09/2013; 10(7). · 1.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Appropriate use of opioids is essential to manage moderate-to-severe pain in children safely and effectively, yet published guidance regarding opioid treatment for pediatric patients is limited, potentially resulting in excessive variation in opioid use in pediatric patients across hospitals in the U.S. To evaluate hospital variation in opioid use in pediatric inpatients. Using data from the Pediatric Health Information System and the Premier Perspective Database regarding all pediatric inpatients in 626 hospitals, we examined hospital variation in opioid use and length of opioid use, adjusting for patient demographic and clinical characteristics, and for hospital type (children's versus general) and hospital patient volume, using multilevel generalized linear regression modeling. Overall, 41.2% of all pediatric hospitalizations were exposed to opioids. Among the exposed patients, the mean length of exposure was 4.6 days. Exposure proportion and exposure length varied substantially across hospitals, even after accounting for patient demographic and clinical characteristics, hospital type and hospital patient volume, especially among terminal hospitalizations. For patients discharged alive versus died, the adjusted exposure percentage for each hospital ranged from 0.7 to 99.1% (interquartile range (IQR): 35.3, 59.9%) versus 0.1-100.0% (IQR: 29.2, 66.2%), and the adjusted exposure length ranged from 1.0 to 8.4 days (IQR: 2.2, 2.7) versus 0.9 to 35.2 days (IQR: 4.0, 7.4). The substantial hospital-level variation in opioid use in pediatric inpatients suggests room for improvement in clinical practice.
    Journal of pain and symptom management 04/2014; · 2.42 Impact Factor