From the Journals

PICU, hospital admissions up due to opioid ingestion

Key clinical point: The rate of hospitalizations and pediatric ICU admissions are up due to opioid ingestion.

Major finding: Over 40% of pediatric patients admitted to hospitals required PICU care.

Study details: A retrospective cohort study of children aged 1-17 years who were admitted to a PICU between Jan. 1, 2004, and Sep. 30, 2015.

Disclosures: This study had no external funding. Dr. Allison H. Bartlett has served as a consultant member of the CVS Caremark National Pharmacy and Therapeutics Committee. All other authors had no relevant financial disclosures to report.

Source: Kane JM et al. Pediatrics. 2018 Mar. 5;141(4):e20173335.


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Pediatric opioid use: The true cost

The opioid crisis in the United States is staggering. As of 2016, an estimated 2.4 million Americans were considered to have an opioid use disorder, either from prescription drug misuse or heroin addiction. This number includes 0.6% of adolescents (12- to 17-year-olds) and 1.1% of young adults (18- to 25-year-olds). And 33,000 Americans died from opioid overdose in 2015. Despite the best attempts to control the supply of drugs and increase access to treatment, overdose deaths have doubled in the past 10 years. While the overdose death rate has plateaued among children under the age of 18, and misuse rates have dropped among 12th graders, opioid-related hospitalizations are increasing in preschool-age children and adolescents.

Prior to the work of Kane et al., little was known about critical care resource usage among pediatric patients admitted to pediatric ICUs across the country. They found that hospitalization rates were up, with over one-third of patients requiring mechanical ventilation and about 20% needing vasopressors. Perhaps one of the most important findings is that methadone accounted for nearly 20% of opioids ingested, displaying how adults being treated for their own opioid use disorder can put the children they live with at risk.

As the opioid crisis has worsened and overdoses have increased, the Council of Economic Advisers attempted to measure the societal costs of opioid overdoses using the “value of a statistical life” analytic method. This considers activities other than just lost work productivity and earnings, such as volunteering and raising a family. Using the value of a statistical life method, the Council determined that the true cost to society was nearly $504 billion, which included both fatal and nonfatal overdoses, and is approximately 2.8% of the 2015 U.S. gross domestic product.

Clearly, opioid abuse is both an emotional and financial burden to individual families and society as a whole. Pediatricians must help combat the ongoing opioid crisis in this country by addressing the needs of pediatric patients.

Sheryl A. Ryan, MD, is a pediatrician at Penn State Health Children’s Hospital, Milton S. Hershey Medical Center in Hershey, Pa. She wrote this commentary to the article by Kane et al. (Pediatrics. 2018 Mar. 5;41(4):e20174129). There was no external funding for this commentary, and Dr. Ryan said she had no relevant financial disclosures.



Hospitalization and pediatric ICU admission rates for pediatric opioid-related ingestion are increasing, along with hospitalization costs, according to a retrospective cohort study.

“In this study, we demonstrate a significant and steady increase in the diagnosis of opioid ingestion and poisoning across all age groups in U.S. children’s hospitals from 2004 to 2015,” wrote Jason Kane, MD, of the University of Chicago, and his associates. “Not only did the absolute number of opioid-related admissions increase but the rate of both hospital and PICU [pediatric ICU] admissions increased as well.”


Using the Pediatric Health Information System database, the research team performed a retrospective cohort study of children aged 1-17 years who had been admitted to a PICU between Jan. 1, 2004, and Sep. 30, 2015. For statistical analysis, the years were grouped into separate epochs: 2004-2007, 2008-2011, and 2012-2015.

Of the 4,175,624 admissions to 31 different children’s hospitals around the United States, 3,647 (0.09%) were due to opioid-related conditions. Across the three epochs of the study, the number of opioid-related hospitalizations more than doubled from 797 to 1,504 and concurrently increased the rate of hospital admissions from 6.7 per 10,000 in 2004 to 10.9 per 10,000 in 2015 (P less than .001).

Similar to the trends in overall hospital admissions and hospital admission rates, admission to the PICU and PICU admission rates also increased. Of the 3,647 children admitted for opioid-related issues, 1,564 (43%) were subsequently admitted to the PICU. PICU admission rates also increased from 25 to 36 per 10,000 admissions (P less than .001).While the majority of opioid-related hospitalizations are associated with children aged 12-17 years, children under the age of 6 years accounted for one-third of these hospitalizations. Many PICU admissions are severe enough to warrant mechanical ventilator support (37%, P less than .001) and vasopressors (20%, P less than .001).

The opioids ingested prior to hospital admission varied between age groups, with 20% (243 of 1,249) patients aged 1-5 years ingesting methadone, compared with 10% (218 of 2,223) of patients aged 12-17 years. Heroin was much more common in this group, accounting for 4.4% (99 of 2,223) of patient hospitalizations.

In addition to the human cost of pediatric hospital admissions, there is a significant economic cost on the health care system. The median cost for PICU admission was $4,931. Although these costs have been dropping for the better part of a decade ($6,523 in 2004-2007 to $4,552 in 2012-2015, P less than .001), it still represents a substantial problem. In addition, admission rates are increasing, which will only place a heavier burden on the health care system, according to Dr. Kane and his associates.

Perhaps one positive point from this study is that although hospitalizations and intensive care rates have gone up, mortality decreased over time from 2.8% in 2004-2007 to 1.3% in 2012-2015.

A possible limitation of the data in this study is that it provides data from subjects whose data is accessible to the researcher, rather than those strategically selected. In addition, referral bias may reduce the ability to generalize the information to non–tertiary care childre­n’s hospitals.

“The current U.S. opioid crisis is negatively impacting pediatric patients as the rate of hospitalization and PICU care for the ingestion of opioids by children continues to increase over time,” wrote Dr. Kane and his associates. “Current efforts to reduce prescription opioid use in adults have not curtailed the incidence of pediatric opioid ingestion, and additional efforts are needed to reduce preventable opioid exposure in children.”

This study had no external funding. Dr. Allison H. Bartlett has served as a consultant member of the CVS Caremark National Pharmacy and Therapeutics Committee. All other authors had no relevant financial disclosures to report.

SOURCE: Kane JM et al. Pediatrics. 2018 Mar 5;141(4):e20173335.

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