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Characteristics of opioid prescriptions for discharged pediatric emergency department patients with acute injuries
  1. Lauren Krystine Kahl1,
  2. Martha W Stevens1,
  3. Andrea C Gielen2,
  4. Eileen M McDonald2,
  5. Leticia Ryan1
  1. 1 Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Johns Hopkins Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr. Lauren Krystine Kahl, Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA; lkahl4{at}


This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1–50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.

  • oral medicine
  • pain
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  • Contributors LR and LKK conceived and designed the study. LR supervised the conduct of the study and data collection. LKK collected and managed the data. LR, MWS, ACG, ESM, and LKK provided advice on study design. LR and LKK analyzed the data. LKK drafted the manuscript, and all authors contributed substantially to its revision. LR and LKK take responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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