No Evidence of Deficient Pain Management With Waning Opioid Use for Pediatric Fracture

As opioid prescription rates have been declining, there has been little evidence of inadequate pain management among pediatric patients with fractures, according to the results of a study published in the American Journal of Emergency Medicine.

This retrospective analysis evaluated opioid prescription trends and inadequate pain management among pediatric patients (N=4713) who presented at a high-volume county hospital emergency department (ED) with acute fractures between 2007 and 2017.

Approximately two-thirds of the study population were boys.  The mean age of study participants was 11.93 (standard deviation [SD], 4.93) years, 82.5% had a single fracture, and most fractures occurred in the arm or hand.

Intravenous narcotics were given to 18.5% of patients, and oral narcotics were given to 16.0% of patients. The most common narcotics administered were morphine (12.9%) and oxycodone (11.8%). Opioid prescriptions were provided to 39.1% of patients who were discharged from the ED and 65.1% of patients who were discharged from inpatient services.

Stratified by year, the proportion of patients receiving opioids decreased from 54.76% in 2007 to 13.59% in 2017. There was no clear pattern in opioid dosing, which ranged from 91.67 morphine equivalents in 2007 to 117.76 morphine equivalents in 2015.

Over the entire study period, 27 patients returned to the ED due to inadequate pain control. There was no trend observed for the number of patients returning to the hospital due to pain on the basis of opioid administration practices. Stratified by receipt of opioids, 0.28% of patients who received opioids and 0.48% of patients who did not receive opioids complained of inadequate pain control. The difference in reports of inadequate pain control among patients receiving or not receiving opioids was not clinically significant.

A major limitation of this study was the lack of data on qualitative pain measures.

Study authors conclude, “This study demonstrated that opioids have been widely used for pediatric fractures, but that the percentage of patients receiving an opioid prescription from the ED steadily decreased between 2007 and 2017. Within the study population, there was a very low return-to-ED rate for pain control reasons and there were no overdoses noted, suggesting that current prescription practices may appropriately balance safety and comfort.”