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Opioid-related ED visits rose 53% among children within 5 years
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Allareddy
CHICAGO — Every day in the United States, approximately 117 children in EDs test positive for opioid abuse or dependence, with reported annual numbers rising from 32,235 in 2008 to 49,626 in 2013, according to research presented at the AAP 2017 National Conference & Exhibition.
“Opioid abuse has been perceived as a problem, and it is definitely a problem in adults; yet our study has shown that there is clearly a problem in the pediatric age group,” Veerajalandhar Allareddy, MD, medical director of the pediatric intensive care unit at the University of Iowa Stead Family Children's Hospital, told Infectious Diseases in Children in an interview.
“However, this may be an underestimated problem because not all children are being tested, only the ones where the physician believes they are a concern,” Allareddy said. “In our opinion, this is just the tip of the iceberg, skimming the very top of a pediatric public health crisis.”
To evaluate the prevalence of opioid dependence and abuse in children who present to an ED for any cause within the U.S., the researchers used data collected between 2008 and 2013 by the Nationwide Emergency Department Sample. They examined all cases in which diagnoses were assigned and codes were entered for opioid abuse and dependence for those aged up to 21 years, and ED charges and disposition status after ED visits were analyzed using multivariable linear and logistic regression models.
Between 2008 and 2013, 257,165 diagnoses of opioid abuse or dependence were given in the United states for those up to 21 years. A significant increase in ED visits was noted, from 32,235 in 2008 to 49,626 in 2013. Of these diagnoses, 88.3% were for those aged 18 to 21 years, and 8.4% were those between the ages of 16 and 17 years.
Ranges in the form of opioid dependence were observed, from unspecified (n=79,789), continued (n = 44,960), episodic (n = 723) and in remission (n = 3,948). These ranges were also noted in opioid abuse rates, with unspecified (111,219), continued (n = 11,182), episodic (n = 1,841) and in remission (n = 4,913). Of all cases, 52.8% were routinely discharged, and 31.4% were subsequently admitted into the hospital. Two hundred patients died in the ED, and 325 died after hospitalization.
Those insured by Medicaid encompassed 27.1% of all ED visits, and 41.4% were privately insured. Uninsured patients accounted for 24.8% of those seen in the ED. No chronic comorbid condition was observed in 92% of the patients seen.
The cost of these ED visits averaged to $2,372, with a national cost of $505 million. Hospital stays had an average cost of $25,356 and a national cost of $2 billion. Patients who were diagnosed with unspecified opioid abuse accumulated the highest ED costs (P < .01), as did those between 13 and 15 years (P = .04), those between 16 and 17 years (P = .01), girls (P = .04), those with comorbid conditions (P = .03) and those within the Western U.S. (P < .01).
Hospitalizations were most frequent in those aged up to 9 years (P <0.01), those with a growing comorbid burden (P < .01) living in the Northeast/Midwest/Southern regions (P < .01) and those who reside in high-income households (P < .01) as opposed to frequent ED discharges. Those without insurance were less likely to be hospitalized for opioid abuse or dependence (P < .01).
“The first thing we have to do as physicians is to define what the problem is,” Allareddy told Infectious Diseases in Children. “We need to screen the child with a very good history and physical, and if there are some symptoms, test the child; if they are positive, there needs to be a way of evaluating why the child is taking opioids. We have to define the problem at an etiological level, a clinical level and at a biological level, which means that extensive research is needed to further define and manage this crisis.”— by Katherine Bortz
Reference:
Allareddy V, et al. Opioid abuse in children: An emerging public health crisis. Presented at: The 2017 AAP National Conference & Exhibition; Sept. 16-19; Chicago.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Daniel M. Fein, MD
It is quite simply shocking to see a 50% increase in children in an ED diagnosed with opioid-related problems between 2008 and 2013 — given everything we hear in the news, there is no doubt that the number is significantly higher in 2017!
This study shows that this is a major problem that needs to be on the forefront of our minds whenever we see a child showing even some vague signs of opioid intoxication. Another important step is that we need to have robust systems in place to ensure drug counseling services are available for these children and their families to try to break the habit early, before it becomes a life-long problem or it becomes deadly.
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