Safety Assessment of Perioperative Pain Medications for Children (SAPPhire)

儿童围手术期止痛药的安全性评估 (SAPPhire)

• 批准号: 10472724
• 负责人: Mehul V. Raval
• 金额: $ 20万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-20 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10472724
• 关键词: Acetaminophen; Address; Adherence; Admission activity; Adolescent; Adoption; Adult; Affect; American College of Surgeons; Analgesics; Anesthetics; Brain; Caregivers; Catalogs; Child; Childhood; Clinical; Codeine; Collection; Critical Care; Data; Data Collection; Data Sources; Development; Drug Prescriptions; Drug usage; Electronic Health Record; Ensure; Equilibrium; Exposure to; Feedback; Fright; Future; Guidelines; Health; Healthcare; Home; Hospitalization; Hospitals; Illinois; Impairment; Information Systems; Intervention; Knowledge; Lead; Length of Stay; Local Anesthetics; Measurement; Measures; Minor; Nerve Block; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Operative Surgical Procedures; Opioid; Outcome; Outpatients; Pain; Pain Measurement; Pain management; Pathway interactions; Patient Outcomes Assessments; Patients; Pediatric Hospitals; Pediatric Surgical Procedures; Perioperative; Physicians; Population; Population Heterogeneity; Postoperative Pain; Postoperative Period; Practice Management; Procedures; Recommendation; Recording of previous events; Registries; Reporting; Research; Risk Factors; Rural; Safety; Services; Subgroup; Surgeon; Surgical Wound Infection; Surveys; Training; United States; United States Food and Drug Administration; Variant; comorbidity; demographics; early adolescence; early childhood; evidence based guidelines; health data; hospital readmission; improved; individual patient; innovation; inpatient surgery; non-opioid analgesic; nonmedical use; opioid epidemic; opioid exposure; opioid misuse; opioid overdose; opioid use; patient subsets; patients who use opioids; pediatric patients; pill; prescription opioid; prescription opioid misuse; programs; safety assessment; surgery outcome

PROJECT ABSTRACT Per capita opioid prescribing is higher in the US than in any other nation and the opioid crisis affects not only adults, but, also children and adolescents. Despite increases in pediatric hospitalizations related to opioid poisonings and opioid-related critical care unit admissions, yet, opioid use in children is understudied and underestimated. This gap in research is alarming given that drug use impairs child brain development and use of prescription opioids during childhood/early adolescence is a risk factor for prescription opioid misuse. One path to childhood opioid misuse begins with exposure after surgery for pain control and more than 2 million children undergo surgery in the US each year. Evidence also suggests that pediatric surgeons often prescribe more opioids than necessary following minor procedures with more than 50% of prescribed pills remaining unused, and resulting in excess opioids being stored in homes with children and, thus, becoming accessible for nonmedical use. Currently, no comprehensive data source exists that catalogues pediatric surgery perioperative pain management practices, including pain medication prescribing and that also assesses pain control, both of which are necessary to develop evidence-based recommendations for pediatric surgery perioperative pain management. This project, Safety Assessment of Perioperative Pain Medications for Children (SAPPhire),will create this unique data source to study, understand, and improve current pediatric surgery perioperative pain management, by combining data about current pain management practices (e.g., local anesthetics, regional nerve blocks, non-opioid analgesics, and pediatric-specific opioid prescribing practices), with patient-level demographic, health (e.g., comorbid conditions, surgical procedure), and outcomes (e.g., length of stay, surgical-site infections, and readmission) data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P). In addition, post-discharge opioid use and patient reported outcomes (PROs) on pain control and limitations of daily activities will be collected. Combined, these data will guide feedback and interventions to address surgeon- and hospital-level pain management practice variation and identify high “opioid-use” procedures and high “opioid-exposed” subgroups of pediatric surgical patients. The study will also assess adherence to FDA opioid medication contraindications and warnings. This formative study will provide essential information needed to develop pediatric procedure- and patient-specific guidelines for pain management. Lessons learned from SAPPhire will facilitate wider adoption of perioperative pain management practices across to the >150 NSQIP-P hospitals across the United States.

项目摘要 在美国，人均开处方的处方比其他任何国家都高，而Ooid危机不会影响 只有成年人，但也是儿童和青少年。尽管与阿片类药物有关的儿科住院治疗增加 中毒和与OIOID相关的重症监护病房的入院 被低估了。鉴于药物使用会损害儿童脑发育和使用，这一研究差距令人震惊 儿童/青少年早期的处方阿片类药物是处方阿片类药物滥用的危险因素。一 童年时期阿片类Missuse始于手术控制后的疼痛控制和超过200万 儿童每年在美国接受手术。证据也表明小儿外科医生经常开处方 在次要程序之后，超过50％的处方药剩下的次要手术要多于必要的阿片类药物 未使用，导致多余的阿片类药物存储在带孩子的家中，因此可以使用 非医学用途。 目前，尚无综合数据源可以分类儿科手术周期性疼痛 管理实践，包括止痛药处方并评估疼痛控制 这对于为小儿手术期制定基于证据的建议是必要的 管理。该项目是对儿童（蓝宝石）的围手术期止痛药的安全评估，将 创建此独特的数据源来研究，理解和改善当前的小儿手术周期性疼痛 管理，通过结合有关当前疼痛管理实践的数据（例如，局部麻醉剂，区域性 神经阻滞，非阿片类镇痛药和小儿特异性的阿片类药物处方实践），患者级别 人口统计，健康（例如合并症，外科手术程序）和结果（例如，住院时间， 来自美国外科医生学院（ACS）国家手术的数据 质量改进程序 - 培训（NSQIP-P）。此外，分娩后阿片类药物的使用和患者报告 将收集有关控制疼痛和日常活动局限性的结果（专业）。这些数据结合在一起 指南反馈和干预措施以解决外科医生和医院水平的疼痛管理实践变化 并确定儿科手术患者的高“阿片类药物使用”程序和高“阿片类药物暴露”亚组。 该研究还将评估遵守FDA阿片类药物的禁忌症和警告。这种格式 研究将提供开发小儿程序和特定于患者指南所需的基本信息 用于疼痛管理。从蓝宝石中学到的教训将有助于更广泛地采用周期性的痛苦 美国> 150个NSQIP-P医院的管理实践。