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Study: More children landing in PICU after ingesting opioids:

March 5, 2018
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The number of children admitted to hospital intensive care units for opioid poisoning nearly doubled over a decade, according to a new study.

“Current efforts to reduce prescription opioid use in adults have not curtailed the incidence of pediatric opioid ingestion, and additional efforts are needed to reduce preventable opioid exposure in children,” authors wrote in the study “Opioid-Related Critical Care Resource Utilization in U.S. Children’s Hospitals” (Kane JM, et al. Pediatrics. March 5, 2018, https://doi.org/10.1542/peds.2017-3335).

Researchers analyzed 2004-’15 data from the Pediatric Health Information System and found 3,647 opioid-related hospitalizations across 31 children’s hospitals. They rose from 797 in 2004-’07 to 1,504 in 2012-’15 and were highest among children ages 12-17 (61%) followed by ages 1-5 (34.2%) and ages 6-11 (4.8%). Nearly 20% of children in the youngest age group were admitted for methadone ingestion.

“The exploratory nature of young children makes them particularly vulnerable to harm from accidental medication ingestions, as opposed to adolescents and teenagers who are more likely to have intentional ingestions including for recreational purposes or for self-harm,” authors wrote.

About 43% of opioid-related hospitalizations required admission to the pediatric intensive care unit (PICU). They nearly doubled from 367 in 2004-’07 to 643 in 2012-’15, according to the study.

Use of mechanical ventilation dropped from 45.8% to 31.6%, and use of vasopressors dropped from 27% to 17.7%. Deaths among children hospitalized for opioid poisoning also decreased from 2.8% to 1.3%. Those declines likely factored into the decrease in median costs per PICU admission from $6,253 to$4,552.

“… the pediatric health care system has become more efficient with lower lengths of stay per hospitalization, less mechanical ventilation per hospitalization, less vasopressors use per hospitalization and reduced mortality over time,” authors wrote.

However, they noted overall costs to the health care system have increased due to rising number of children being hospitalized for opioid ingestion. The majority were covered by Medicaid, and this coverage was highest among young children.

“… any reduction of Medicaid funding could have a profound impact on the ability to recuperate the cost of acute hospital care that is associated with pediatric opioid ingestions,” according to the study.

Authors called for additional efforts to keep children away from opioids, which was echoed in a commentary by Sheryl A. Ryan, M.D., FAAP, a member of the AAP Section on Adolescent Health.

“Several highly effective, evidence-based programs have been shown to reduce the use and abuse of alcohol and other drugs, including opioids, by adolescents and young adults,” she wrote. “Findings from the work by Kane et al. highlight the need for pediatricians to engage in this critical work to combat the ongoing opioid crisis in our country.”