Background: 

Opioids constitute the fastest-growing drug problem among children and adolescents in the United States. Recent heavy media coverage on the opioid prescription epidemic has garnered increased attention from prescribers and policymakers. The purpose of this study was to analyze trends in opioid prescribing for nonoperatively managed pediatric fractures and dislocations in order to examine changes in opioid-prescribing patterns across various U.S. regions.

Methods: 

A retrospective review of the national Pediatric Health Information System (PHIS) database comprising 42 pediatric hospitals was performed to identify pediatric fractures and dislocations presenting to the emergency department (ED) or outpatient clinics from 2004 to 2017. We included patients with the 10 most frequently encountered diagnoses who were nonoperatively managed and were discharged home the same day. To account for hospital variation, we utilized a mixed-effects logistic regression model.

Results: 

The final cohort included 134,931 patients, with a mean age (and standard deviation) of 12.57 ± 2.00 years (range, 10 to 18 years); 69.23% of patients were male. Overall, 51.69% of patients were prescribed at least 1 opioid dose during their ED or clinic visits. Of the patients receiving opioids, 72.04% were male and 54.10% were insured through a private insurance plan. When prescription trends were compared according to regions, children were more likely to be prescribed opioids in the South (71.37% more likely) and the Midwest (26.17% more likely) than in the Northeast.

Conclusions: 

Although the opioid prescription rates in all 4 regions have decreased dramatically over the years, some regions were quicker than others in responding to the opioid epidemic. A significant interregional variability in opioid-prescribing practices still exists, but an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.

Clinical Relevance: 

Opioid-related misuse is a national epidemic and reducing the use of opioids in pediatric orthopaedic procedures is critical. Although regional variability in opioid-prescribing practices still exists, an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.

中文翻译：

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获取信息：阿片类药物处方用于儿童和青少年轻微骨科损伤的趋势正在下降

背景： 

阿片类药物是美国儿童和青少年中增长最快的毒品问题。最近媒体对阿片类药物处方流行的大量报道引起了开处方者和政策制定者的更多关注。本研究的目的是分析非手术治疗儿科骨折和脱位的阿片类药物处方趋势，以检查美国不同地区阿片类药物处方模式的变化。

方法： 

对由 42 家儿科医院组成的国家儿科健康信息系统 (PHIS) 数据库进行回顾性审查，以确定 2004 年至 2017 年急诊科 (ED) 或门诊的儿科骨折和脱位。我们纳入了 10 名最常见的患者遇到了非手术治疗并在同一天出院回家的诊断。为了考虑医院变异，我们使用了混合效应逻辑回归模型。

结果： 

最终队列包括 134,931 名患者，平均年龄（和标准差）为 12.57 ± 2.00 岁（范围为 10 至 18 岁）；69.23%的患者为男性。总体而言，51.69% 的患者在 ED 或门诊就诊期间至少服用 1 剂阿片类药物。在接受阿片类药物的患者中，72.04% 为男性，54.10% 通过私人保险计划投保。当根据地区比较处方趋势时，与东北部相比，南部（71.37% 的可能性）和中西部（26.17% 的可能性）的儿童更有可能服用阿片类药物。

结论： 

尽管多年来所有 4 个地区的阿片类药物处方率都急剧下降，但一些地区对阿片类药物流行的反应比其他地区更快。在阿片类药物处方实践中仍然存在显着的区域间差异，但在保守治疗的儿科骨折和脱位中用于急性疼痛管理的阿片类药物处方率总体呈下降趋势，这表明在应对阿片类药物危机方面取得了进展。

临床相关性： 

阿片类药物相关的滥用是一种全国性流行病，减少儿科骨科手术中阿片类药物的使用至关重要。尽管阿片类药物处方实践的区域差异仍然存在，但在保守治疗的小儿骨折和脱位中急性疼痛管理的阿片类药物处方率总体呈下降趋势，这表明在应对阿片类药物危机方面取得了进展。