Chronic Opioid use in Adult Survivors of Pediatric ICU Admissions in Nova Scotia: A Retrospective Cohort Study
Ayush Lacoul, Tobias Witter, Kristina Krmpotic, Kirstin Crabtree, Lilian Cristina Gomez, Jennifer R. FosterObjective
Although opioids are used frequently in pediatric intensive care units (PICUs) for analgesia and safety, the long-term consequences of opioid exposure in PICU are unknown. We performed this exploratory study to examine the relationship between PICU-related opioid exposure and chronic prescription opioid use in adult survivors. Our primary outcome was the prevalence of chronic prescription opioid use, defined as filled opioid prescriptions covering >70% of days within a 3-month period during the adult observation period.
Design and setting
: We performed a single-center, retrospective cohort study linking PICU admission-based data from childhood with opioid prescription data in adulthood via the Nova Scotia Prescription Monitoring Program (NSPMP).
Patients
We included children (birth to 16 years) who required PICU admission for critical illness that included opioid exposure and ≥48 h of mechanical ventilation after January 1, 1995 and reached adulthood (18 years) by January 1, 2015. We examined adult opioid prescription data for the 5 years from 2015 to 2019.
Interventions
None
Measurements and main results
Of 313 eligible participants, we excluded 194 for death, migration, or loss to follow-up; 119 were included. Six (5%) met criteria for chronic prescription opioid use as an adult. Compared with participants who had chronic opioid use, those without chronic opioid use had significantly fewer PICU admissions in childhood (median [IQR] = 3[1–6] vs 1[1–2] respectively, p = 0.040) and a higher mean Therapeutic Intervention Scoring System score (surrogate for severity of illness, mean [SD] = 29.3[6.6] vs 35.9[7.4], p = 0.036), but no difference in cumulative opioid exposure (median [IQR] mg/kg morphine equivalents = 8.4 [3.2-11.4] vs 7.3 [2.8-17.0], p = 0.49).
Conclusion
Adult survivors of pediatric ICU admissions demonstrated a prevalence of chronic prescription opioid use of 5%. Pediatric critical illness necessitating PICU admission and opioid prescription were not associated with chronic opioid prescription use in our cohort.