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PLoS One. 2019 Dec 16;14(12):e0226433. doi: 10.1371/journal.pone.0226433. eCollection 2019.

The use of opioids in low acuity pediatric trauma patients.

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Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, United States of America.



To describe temporal trends and factors associated with opioid administration among children discharged from the emergency department (ED) after a trauma visit.


This was a cross-sectional study of ED visits for children <19 years old who received a trauma-related diagnosis and were discharged from the ED. Data were obtained from the National Hospital Ambulatory Medical Care Survey 2006-2015.


Administration of an opioid medication either during the ED visit or as a discharge prescription. Survey-adjusted regression analyses were used to determine the probability of a patient receiving an opioid medication.


During the study period, there were 19,241 pediatric trauma visits discharged from the ED, of which 14% were associated with an opioid. Opioid administration decreased by nearly 30% during the study period (p<0.001 for trend). In multivariable analysis, patient factors associated with opioid administration were adolescent age, evening visit, region of the country, and severe pain score. The diagnosis associated with the most opioids was ankle sprain and the diagnosis with the highest rate of opioid administration was radius fracture. The most common opioid administered to children under 12 years of age was acetaminophen-codeine.


Opioid administration appears to be decreasing among pediatric patients presenting to the ED with trauma, but a high number of children continue to be exposed to opioids every year. Further education on opioid sparing pain management strategies may be warranted to decrease opioid exposure, including the inappropriate use of codeine, in this low risk trauma population.

Conflict of interest statement

The authors have declared that no competing interests exist.

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