Counseling for opioids prescribed at discharge of hospitalized adolescent trauma patients

Michael J Mello¹, Lois K Lee², Emily Christison-Lagay³, Anthony Spirito⁴, Sara Becker⁵, Julie Bromberg⁶, Stephanie Ruest⁶, Mark R Zonfrillo⁶, Kelli Scott⁵, Charles Pruitt⁷, Karla Lawson⁸, Isam Nasr⁹, Jeremy Aidlen¹⁰, Janette Baird⁶

Affiliations

¹ Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA. mjmello@lifespan.org.
² Division of Emergency Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, USA.
³ Yale Pediatric Surgery, Yale New Haven Children's Hospital, 1 Park Street, New Haven, CT, USA.
⁴ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, USA.
⁵ Feinberg School of Medicine Center for Dissemination and Implementation Science, Northwestern University, 633 North St Clair, 20th Floor, Chicago, IL, USA.
⁶ Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA.
⁷ Pediatric Emergency Medicine, Primary Children's Hospital, 100 N Mario Capecchi Dr, Salt Lake City, UT, USA.
⁸ Dell Children's Trauma and Injury Research Center, Trauma Services, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd., Austin, TX, USA.
⁹ Division of Pediatric Surgery, Johns Hopkins Children's Center, The Johns Hopkins Hospital, 1800 Orleans St. The Charlotte R. Bloomberg Children's Center Building, Suite 7323, Baltimore, MD, USA.
¹⁰ Division of Pediatric Surgery, UMass Memorial Medical Center - University Campus, 55 Lake Avenue North, Worcester, MA, USA.

PMID: 37872639
PMCID: PMC10594678
DOI: 10.1186/s40621-023-00465-2

Counseling for opioids prescribed at discharge of hospitalized adolescent trauma patients

Michael J Mello et al. Inj Epidemiol. 2023.

. 2023 Oct 23;10(Suppl 1):53.

doi: 10.1186/s40621-023-00465-2.

Authors

Affiliations

¹ Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA. mjmello@lifespan.org.
² Division of Emergency Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, USA.
³ Yale Pediatric Surgery, Yale New Haven Children's Hospital, 1 Park Street, New Haven, CT, USA.
⁴ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, USA.
⁵ Feinberg School of Medicine Center for Dissemination and Implementation Science, Northwestern University, 633 North St Clair, 20th Floor, Chicago, IL, USA.
⁶ Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA.
⁷ Pediatric Emergency Medicine, Primary Children's Hospital, 100 N Mario Capecchi Dr, Salt Lake City, UT, USA.
⁸ Dell Children's Trauma and Injury Research Center, Trauma Services, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd., Austin, TX, USA.
⁹ Division of Pediatric Surgery, Johns Hopkins Children's Center, The Johns Hopkins Hospital, 1800 Orleans St. The Charlotte R. Bloomberg Children's Center Building, Suite 7323, Baltimore, MD, USA.
¹⁰ Division of Pediatric Surgery, UMass Memorial Medical Center - University Campus, 55 Lake Avenue North, Worcester, MA, USA.

PMID: 37872639
PMCID: PMC10594678
DOI: 10.1186/s40621-023-00465-2

Abstract

Background: Expert consensus recommends prescription opioid safety counseling be provided when prescribing an opioid. This may be especially important for youth with preexistent alcohol and other drug (AOD) use who are at higher risk of developing opioid use disorder. This study examined the frequency that adolescent trauma patients prescribed opioids at hospital discharge received counseling and if this differed by adolescents' AOD use.

Method: This study was embedded within a larger prospective stepped-wedge type III hybrid implementation study of AOD screening across a national cohort of pediatric trauma centers. Data were collected during 2018-2021 from admitted adolescent trauma patients (12-17 yo) at seven centers. Patient data were extracted from the electronic health record (EHR) on any prescribed discharged opioids, documentation of counseling delivered on prescribed opioid, who delivered counseling, and patients' AOD screening results. Additionally, adolescents received an online survey within 30 days of hospital discharge that included asking about hospital discussions on safe use of prescription pain medication.

Results: Of the 247 adolescent trauma patients enrolled, 158 completed the 30-day survey. AOD screening results were documented in the EHR for 139 patients (88%), with 69 (44.1%) screening AOD-positive. Opioids at discharge were prescribed to 86 (54.4%) adolescent patients, with no significant difference between those screened AOD-positive and AOD-negative (42.4% vs. 46.3%, p = 0.89). Counseling was documented in the EHR for 30 (34.9%) of those prescribed an opioid and was not significantly different by sex, age, race, ethnicity or between adolescent patients with documentation of AOD use (29.3%) versus those who did not (33.3%, p = 0.71). According to the adolescent survey, among those prescribed an opioid, 61.2% reported someone had talked with them about safe use of newly prescribed pain medications with again no difference between AOD-positive and AOD-negative screening results (p = 0.34).

Conclusions: Although adolescent trauma patients recalled discussions on safe use of prescribed pain medication more often than was documented in the EHR, these discussions were not universal and did not differ if adolescents had screened positive or negative for AOD use as documented in the EHR.

Trial registry: clinicaltrials.gov NCT03297060.

Keywords: Adolescent; Pediatric trauma centers; Prescription opioids.

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Conflict of interest statement

There are no competing interests to report.

Figures

**Fig. 1**
Participant enrollment, distribution, and retention

See this image and copyright information in PMC

References

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Counseling for opioids prescribed at discharge of hospitalized adolescent trauma patients

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Counseling for opioids prescribed at discharge of hospitalized adolescent trauma patients

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