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Are Narcotic Prescriptions Actually Filled for Injured Children? Findings Gleaned from a Statewide Prescription Monitoring Program
Alexis D. Smith1, Britta Renzulli1,2, Kelly Corbett1, Michael J. Mello2,3, Janette Baird2,3, Thomas F. Tracy1,2, Charles A. Adams, Jr.2,3, Hale E. Wills1,2. 1Hasbro Children's Hospital, Providence, RI, USA, 2Alpert Medical School, Brown University, Providence, RI, USA, 3Rhode Island Hospital, Providence, RI, USA.

Background: Injured children frequently receive narcotic prescriptions at hospital discharge, yet the proportion that fills those prescriptions is unknown. Our state recently mandated an electronic prescription monitoring program (PMP) which offers an opportunity to assess narcotic usage after trauma.

Methods: Patients <18 years, discharged home from an academic level 1 pediatric trauma center in 2014 were identified. Discharge pain medications were abstracted from EMR, and PMP queried for same patients. US Census Bureau median household family income (MHFI) by ZIP code tabulation area was identified for each patient. Associations between demographics, ISS, and MHFI, and narcotic prescribing or filling were analyzed.

Results: Of 256 children discharged home, 63% received narcotic prescriptions, of which 63.4% were filled. Logistic regression showed increased adjusted OR for prescription filling for age ≥6 y.o. (1.4, 95%CI 1.029-1.991), ISS >4 (2.2, 1.02-4.554), or surgical procedures (5.3, 2.496-11.185), but not for gender, race, ethnicity, or MHFI.

Conclusions: A significant proportion of narcotic prescriptions given to injured children at hospital discharge go unfilled, especially for the youngest. Those with ISS <4 received narcotics prescriptions at the same rate as those with more severe injuries. We did not find correlation between population-based socioeconomic factors and either prescribing or filling narcotics. It is unclear if nonfulfillment represents over-prescribing or under-utilization. The correlation and causes of the discrepancy between narcotic prescribing and filling warrant prospective review.

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