• Amy L Drendel, David C Brousseau, T Charles Casper, Lalit Bajaj, Evaline A Alessandrini, Robert W Grundmeier, James M Chamberlain, Monika K Goyal, Cody S Olsen, and Elizabeth R Alpern.
• Medical College of Wisconsin, Wisconsin.
• Pain Med. 2020 Sep 1; 21 (9): 1947-1954.

ObjectiveTo measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture.DesignA retrospective cohort study of pediatric ED visits in 2015.SettingFour pediatric EDs.SubjectsChildren aged four to 18 years with a long-bone fracture discharged from the ED.MethodsA multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription.ResultsThere were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A = 8.2% (95% confidence interval [CI] = 6.9-9.7%), B = 12.1% (95% CI = 10.5-14.0%), C = 16.9% (95% CI = 15.2-18.8%), D = 23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing.ConclusionsFor children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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