Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain

Leslie M. Okorji, Devin S. Muntz, Robert I Liem*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. Methods: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7–21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns. Results: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5–4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62–2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3–37.3], P = 0.03) but not readmissions. Conclusion: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.

Original languageEnglish (US)
Article numbere26319
JournalPediatric Blood and Cancer
Volume64
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Sickle Cell Anemia
Opioid Analgesics
Prescriptions
Hospital Emergency Service
Pain
Acute Pain
Anti-Inflammatory Agents
Pharmaceutical Preparations
Hospitalization
Outpatients
Retrospective Studies
Logistic Models
Demography
Incidence
Population

Keywords

  • opioids
  • pain crises
  • readmission
  • sickle cell disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

@article{23a6d651656148e2b788a042cdd390a3,
title = "Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain",
abstract = "Background: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. Methods: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7–21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns. Results: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95{\%} CI: 1.5–4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95{\%} CI: 0.62–2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95{\%} CI: 1.3–37.3], P = 0.03) but not readmissions. Conclusion: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.",
keywords = "opioids, pain crises, readmission, sickle cell disease",
author = "Okorji, {Leslie M.} and Muntz, {Devin S.} and Liem, {Robert I}",
year = "2017",
month = "5",
day = "1",
doi = "10.1002/pbc.26319",
language = "English (US)",
volume = "64",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "Wiley-Liss Inc.",
number = "5",

}

Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain. / Okorji, Leslie M.; Muntz, Devin S.; Liem, Robert I.

In: Pediatric Blood and Cancer, Vol. 64, No. 5, e26319, 01.05.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain

AU - Okorji, Leslie M.

AU - Muntz, Devin S.

AU - Liem, Robert I

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. Methods: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7–21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns. Results: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5–4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62–2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3–37.3], P = 0.03) but not readmissions. Conclusion: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.

AB - Background: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. Methods: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7–21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns. Results: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5–4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62–2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3–37.3], P = 0.03) but not readmissions. Conclusion: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.

KW - opioids

KW - pain crises

KW - readmission

KW - sickle cell disease

UR - http://www.scopus.com/inward/record.url?scp=84997124415&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997124415&partnerID=8YFLogxK

U2 - 10.1002/pbc.26319

DO - 10.1002/pbc.26319

M3 - Article

C2 - 27800652

AN - SCOPUS:84997124415

VL - 64

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 5

M1 - e26319

ER -