Pediatric exposure to opioid and sedation medications during terminal hospitalizations in the United States, 2007-2011.
Pediatric exposure to opioid and sedation medications during terminal hospitalizations in the United States, 2007-2011.
复制标题
2007-2011 年美国儿童在临终住院期间接触阿片类药物和镇静药物的情况。
DOI：
10.1016/j.jpeds.2014.10.017
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Feudtner,Chris
中科院分区：
文献类型：
--
作者：
Ragsdale,Lindsay;Zhong,Wenjun;Morrison,Wynne;Munson,David;Kang,TammyI;Dai,Dingwei;Feudtner,Chris
Objective描述使用阿片类药物和镇静剂的儿科患者在医院死亡前2周death.Study designWe进行了一项回顾性研究阿片类药物和镇静药物暴露的儿童谁死在医院在美国通过使用大型行政数据源。我们描述了2007年至2011年期间死亡住院患者（<21岁）（n = 37 459）暴露于这些药物的模式以及与暴露相关的因素。 多变量Logistic回归模型被用来估计ORs.ResultsOverall，74%的患者暴露于阿片类药物或镇静剂在死亡前14天。在死亡前住院6天或以上的患者中，每日暴露率范围为73%（死亡前第6天）至89%（死亡当天）。最常用的药物是芬太尼（52%），咪达唑仑（44%）和吗啡（40%）。年龄较大（OR 1.6-3.7），黑人（OR 0.8），住院时间较长（OR 6.6-9.3），接受医疗干预（包括机械通气、手术和入住重症监护室，OR 1.7-2.6），有合并症（OR 1.7-2.4），在儿童医院住院（OR 4.0-4.5）结论：虽然大多数儿科晚期住院患者暴露于阿片类药物，和镇静药物，有些病人在死前没有接受这些药物。鉴于患者和医院特征与阿片类药物/镇静剂暴露相关，这些发现表明了潜在的质量改进和进一步研究的领域。
ObjectiveTo describe the use of opioids and sedatives to pediatric patients dying in the hospital in the 2 weeks preceding death.Study designWe 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.ResultsOverall, 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.ConclusionAlthough 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.