Background: Appropriate analgesia is important for diagnostic and therapeutic interventions in and out of the Emergency Department (ED). This must be balanced with national concerns of opioid use and abuse in children and adults. Our objective was to evaluate the usage and prescription of opioids from the ED in children with painful conditions over a 10 year period.
Methods: All children less than 18 years of age with a painful condition presenting to an ED in the National Hospital Ambulatory Medical Care Survey (NHAMCS) database from 2005 to 2015 were included. Serial cross-sectional and multivariate regression analyses were performed. Trends were stratified by developmental age.
Results: An estimate 1,616,908 children received opioids in the ED in 2005 compared to 1,378,498 in 2015. Older children were more likely to receive opioids compared to younger children. Those age 12-18 years received 65% of the opioids administered in the ED, and 71% of the prescriptions in 2005. In 2015, older children comprised 64% of those receiving opioids in the ED and 78% of those receiving prescriptions; relative change -1.7% for receiving opioids (p=0.59) and +9.7% for opioid prescriptions from the ED (p=0.30).Overall, 15.2% of the opioids administered in the ED were to children under 6 years of age in 2005, and 15.5% in 2015, relative change +1.5% (p=0.41).The number of opioid prescriptions from the ED declined from 1,514,731 in 2005 to 942,425 in 2015, absolute reduction of 37.8%. This reduction was seen in all age groups over time, -53.7% for children under 6 years, -51.8% for those age 7 to 11 years, and -31.7% for those 12 and older.
Conclusion: There has not been a statistically significant change in the number of children receiving opioids in the ED in the last 10 years; however, the number of children receiving a prescription for opioids has decreased 38% over time.