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Fig. 1 National and regional variances in opioid prescribing rates over the past 14 years
Courtesy of The Children’s Hospital of Philadelphia Orthopaedic Research Team

AAOS Now

Published 6/1/2020
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Kerri Fitzgerald

Study Shows Decline in Opioid Prescribing for Pediatric Fractures, But Demographic Discrepancies Persist

Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

A study observed a significant overall decline in opioid prescription rates during the past 14 years among children and adolescents with minor fractures and dislocations. However, the study demonstrated that there are significant regional and demographic differences in prescribing. Divya Talwar, PhD, MPH, of the Children’s Hospital of Philadelphia, presented the data as part of the Annual Meeting Virtual Experience, on behalf of the principal investigator of the study, Jack M. Flynn, MD, and other coauthors.

“Our findings may indicate that efforts to combat early exposure to opioids have had success in changing the prescribing habits of providers in acute care settings,” Dr. Talwar told AAOS Now.

Researchers retrospectively reviewed the national Pediatric Health Information System database, which includes 42 pediatric hospitals, to identify emergency department (ED) and clinic visits for each of the 10 most frequently encountered pediatric fractures and dislocations from 2004 to 2017. The study only included patients with minor injuries who were nonsurgically managed and discharged home on the same day. Patients were classified based on U.S. region: northeast, Midwest, south, and west.

The final cohort included 120,002 patients (mean age, 12 years; range, 10–18 years; 70.5 percent were male). “Opioid prescriptions in such a young population are quite critical to be assessed because being younger at the time of first exposure to opioids is a risk factor associated with an increased risk of ultimate opioid abuse,” said Dr. Talwar of the study’s population.

Fig. 1 National and regional variances in opioid prescribing rates over the past 14 years
Courtesy of The Children’s Hospital of Philadelphia Orthopaedic Research Team
Table 1 Overall likelihood of receiving an opioid by demographic factors (2004–2017). *P Value < 0.05 Considered Significant. CI, Confidence Interval
Courtesy of The Children’s Hospital of Philadelphia Orthopaedic Research Team

Overall, 54.3 percent of patients received at least one dose of opioids during their ED or clinic visits. Of those receiving opioids, 73.2 percent were male, and 52.0 percent had nongovernment insurance (P < 0.001 for both).

Among the whole patient population, the national opioid prescription rate decreased from 60.0 percent in 2004 to 27.8 percent in 2017, which Dr. Talwar called “heartening.” By 2017, patients were 75 percent less likely to receive an opioid prescription compared to 2004 (P < 0.001).

However, demographic (Table 1) and regional (Fig.1) factors impacted patients’ likelihood of receiving an opioid prescription. “Black patients were 39 percent less likely to receive an opioid prescription than white patients, which presents a racial health disparity,” said Dr. Talwar.

The study is limited by its use of a database, which may introduce coding errors or incomplete data.

Drs. Talwar and Flynn’s coauthors of Poster 718, “Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents over the Past 14 Years,” are Jigar S. Gandhi and Arielle Rose Krakow.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.