Pediatric Exposure to Opioid and Sedation Medications during Terminal Hospitalizations in the United States, 2007-2011

Ragsdale, Lindsay; Zhong, Wenjun; Morrison, Wynne; Munson, David; Kang, Tammy I.; Dai, Dingwei; Feudtner, Chris

doi:10.1016/j.jpeds.2014.10.017

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…Medication use in our study was associated with race and age, which may reflect differences in how patients experience symptoms, as well as differences in provider/patient preferences. Black race has been associated with increased opioid use in children at end of life, but our data suggest this does not apply to pediatric patients with cancer 32 . We found that Black race is associated with decreased use of benzodiazepines, and although not statistically significant, decreased use of opioids.…”

Section: Discussioncontrasting

confidence: 65%

“…Black race has been associated with increased opioid use in children at end of life, but our data suggest this does not apply to pediatric patients with cancer. 32 We found that Black race is associated with decreased use of benzodiazepines, and although not statistically significant, decreased use of opioids. The racial disparities identified in our model are adjusted for the average effect of insurance type; however, they may be confounded by other socioeconomic factors or regional practice variation not evaluated here.…”

Section: Discussionmentioning

confidence: 51%

“…In this study, 80% of patients received opioids on the day prior to death. Although this is higher than prior research reporting 70% opioid exposure among all hospitalized dyingchildren, children with cancer report uncontrolled pain at end of life and may require optimization of opioid administration for adequate pain management 11–14,32 . Additionally, children with cancer often experience anxiety at end of life, yet only 66% of patients received benzodiazepines on the day prior to death 14 .…”

Section: Discussionmentioning

confidence: 92%

“…Although this is higher than prior research reporting 70% opioid exposure among all hospitalized dyingchildren, children with cancer report uncontrolled pain at end of life and may require optimization of opioid administration for adequate pain management. [11][12][13][14]32 Additionally, children with cancer often experience anxiety at end of life, yet only 66% of patients received benzodiazepines on the day prior to death. 14 Interestingly, opioids and benzodiazepines were discontinued in 11% and 10% of patients, respectively, over the last week of life.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of medication use at end of life by pediatric inpatients with cancer

Prozora

Shabanova

Ananth

et al. 2020

Pediatric Blood & Cancer

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Objective To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life. Methods This retrospective study used data from the Vizient Clinical Database/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0‐21 years) with malignancy who died during hospitalization (2010‐2017) were included (N = 1659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti‐infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1 week and 1 day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs). Results Over the last week of life, there was increased use of opioids (76% to 82%, aOR = 1.55, P < .001) and benzodiazepines (53% to 66%, aOR = 1.36, P = .02), while gastrointestinal‐related medication use decreased (92% to 89%, aOR = 0.69, P = .001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR = 0.46, P < .001) and anti‐infectives (82% to 73%, aOR = 0.41, P = .002). Vasopressor use increased as death approached (15% to 28%, aOR = 1.67, P = .04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do‐not‐resuscitate status. Conclusion During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life‐sustaining medications were often continued. Variability in utilization suggests differences in provider/family decision making that warrant further study to develop an evidence‐based approach to end‐of‐life care.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Patterns of medication use at end of life by pediatric inpatients with cancer

Prozora

Shabanova

Ananth

et al. 2020

Pediatric Blood & Cancer

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“…Opioids, benzodiazepines, 1 ketamine, propofol, 2 barbiturates, 3 and neuroleptics are agents utilized to provide sedation to manage refractory pain and symptoms at the end of life. A recent retrospective analysis based on data from the Pediatric Health Information System and Premier Perspective Database between 2007 and 2011 confirmed this, and also noted an increasing use of dexmedetomidine.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine for Sedation during Withdrawal of Support

2015

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Agents used to control end-of-life suffering are associated with troublesome side effects. The use of dexmedetomidine for sedation during withdrawal of support in pediatrics is not yet described. An adolescent female with progressive and irreversible pulmonary deterioration was admitted. Despite weeks of therapy, she did not tolerate weaning of supplemental oxygen or continuous bilevel positive airway pressure. Given her condition and the perception that she was suffering, the family requested withdrawal of support. Despite opioids and benzodiazepines, she appeared to be uncomfortable after support was withdrawn. Ketamine was initiated. Relief from ketamine was brief, and its use was associated with a “wide-eyed” look that was distressing to the family. Ketamine was discontinued and a dexmedetomidine infusion was initiated. The patient’s level of comfort improved greatly. The child died peacefully 24 hours after initiating dexmedetomidine from her underlying disease rather than the effects of the sedative.

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Are We Doing Right by Dying Children?

Derrington

2015

The Journal of Pediatrics

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Pediatric Exposure to Opioid and Sedation Medications during Terminal Hospitalizations in the United States, 2007-2011

Cited by 8 publications

References 26 publications

Patterns of medication use at end of life by pediatric inpatients with cancer

Patterns of medication use at end of life by pediatric inpatients with cancer

Dexmedetomidine for Sedation during Withdrawal of Support

Are We Doing Right by Dying Children?

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