Pediatric exposure to opioid and sedation medications during terminal hospitalizations in the United States, 2007-2011.

TitlePediatric exposure to opioid and sedation medications during terminal hospitalizations in the United States, 2007-2011.
Publication TypeJournal Article
Year of Publication2015
AuthorsRagsdale L, Zhong W, Morrison WE, Munson D, Kang TI, Dai D, Feudtner C
JournalJ Pediatr
Volume166
Issue3
Pagination587-93.e1
Date Published03/2015
ISSN1097-6833
KeywordsAnalgesics, Opioid, Conscious Sedation, Follow-Up Studies, Hospital Mortality, Hospitalization, Humans, Hypnotics and Sedatives, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Retrospective Studies, Terminal Care, Terminally Ill, United States
Abstract

OBJECTIVE: To describe the use of opioids and sedatives to pediatric patients dying in the hospital in the 2 weeks preceding death.

STUDY DESIGN: We conducted a retrospective study on opioid and sedation medication exposure among children who die in hospitals in the US by using large administrative data sources. We described patterns of exposure to these medications for deceased inpatients (<21 years of age) between 2007 and 2011 (n = 37,459) and factors associated with the exposure. Multivariable logistic regression models were used to estimate the ORs.

RESULTS: Overall, 74% patients were exposed to opioids or sedatives in the 14 days before death. Among patients with 6 or more hospital days before death, the daily exposure rate ranged from 73% (the sixth day before death) to 89% (the day of death). The most commonly used medications were fentanyl (52%), midazolam (44%), and morphine (40%). Older age (ORs 1.6-3.7), black race (ORs 0.8), longer hospital stay (ORs 6.6-9.3), receiving medical interventions (including mechanical ventilation, surgery, and stay in the intensive care unit, ORs 1.7-2.6), having comorbidities (ORs 1.7-2.4), and being hospitalized in children's hospitals (ORs 4.0-4.5) were associated with exposure of opioid and sedation medication on adjusted analysis.

CONCLUSION: Although most pediatric patients terminally hospitalized are exposed to opioid and sedation medication, some patients do not receive such medications before death. Given that patient and hospital characteristics were associated with opioid/sedative exposure, these findings suggest areas of potential quality improvement and further research.

DOI10.1016/j.jpeds.2014.10.017
Alternate JournalJ. Pediatr.
PubMed ID25454928
Grant List1R01HS018425 / HS / AHRQ HHS / United States