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Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014).
J Opioid Manag. 2018 Jul/Aug; 14(4):265-272.JO

Abstract

OBJECTIVE

To examine recent trends in and predictors of hydromorphone administration in US emergency departments (EDs) compared with other opioids.

DESIGN

Retrospective review of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2014.

PARTICIPANTS

All adult ED visits where an opioid analgesic was administered were included.

MAIN OUTCOME MEASURES

Trends in and predictors of hydromorphone administration were assessed using survey-weighted logistic regression, comparing hydromorphone visits with ED visits where other opioids were administered.

RESULTS

From 2007 to 2014, in an estimated 128.9 million US ED visits where opioids were administered, hydromorphone use increased significantly from 30.2 percent in 2007 to 36.8 percent of visits in 2014 (p = 0.027). Hydromorphone accounted for a greater proportion of opioids administered by the end of the study period, compared to other opioids. Patient characteristics associated with hydromorphone were age <65 years, white race, private insurance or Medicare, and severe pain. Patients who received hydromorphone also had indicators of higher severity illness, including more laboratory testing, procedures, and higher admission rates. Common conditions where hydromorphone was administered were headache, back pain, musculoskeletal pain, and abdominal pain.

CONCLUSION

From 2007 to 2014, hydromorphone was administered to more than one in three US ED patients who were administered opioids, and several factors predicted its use. High use was found in some conditions where opioid use is inappropriate, suggesting a need for additional initiatives to promote rational prescribing of high-potency opioids.

Authors+Show Affiliations

Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; The Georgetown University School of Medicine, Washington, DC.Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.The George Washington University School of Medicine and Health Sciences, Washington, DC.Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.Department of Emergency Medicine, Perleman School of Medicine, Philadelphia, Pennsylvania.Department of Emergency Medicine, Rutgers New Jersey School of Medicine, Newark, New Jersey.Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30234923

Citation

Mazer-Amirshahi, Maryann, et al. "Trends in and Predictors of Hydromorphone Administration in US Emergency Departments (2007-2014)." Journal of Opioid Management, vol. 14, no. 4, 2018, pp. 265-272.
Mazer-Amirshahi M, Ladkany D, Mullins PM, et al. Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014). J Opioid Manag. 2018;14(4):265-272.
Mazer-Amirshahi, M., Ladkany, D., Mullins, P. M., Motov, S., Perrone, J., Nelson, L. S., & Pines, J. M. (2018). Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014). Journal of Opioid Management, 14(4), 265-272. https://doi.org/10.5055/jom.2018.0458
Mazer-Amirshahi M, et al. Trends in and Predictors of Hydromorphone Administration in US Emergency Departments (2007-2014). J Opioid Manag. 2018 Jul/Aug;14(4):265-272. PubMed PMID: 30234923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014). AU - Mazer-Amirshahi,Maryann, AU - Ladkany,Diana, AU - Mullins,Peter M, AU - Motov,Sergey, AU - Perrone,Jeanmarie, AU - Nelson,Lewis S, AU - Pines,Jesse M, PY - 2018/9/21/entrez PY - 2018/9/21/pubmed PY - 2018/12/21/medline SP - 265 EP - 272 JF - Journal of opioid management JO - J Opioid Manag VL - 14 IS - 4 N2 - OBJECTIVE: To examine recent trends in and predictors of hydromorphone administration in US emergency departments (EDs) compared with other opioids. DESIGN: Retrospective review of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2014. PARTICIPANTS: All adult ED visits where an opioid analgesic was administered were included. MAIN OUTCOME MEASURES: Trends in and predictors of hydromorphone administration were assessed using survey-weighted logistic regression, comparing hydromorphone visits with ED visits where other opioids were administered. RESULTS: From 2007 to 2014, in an estimated 128.9 million US ED visits where opioids were administered, hydromorphone use increased significantly from 30.2 percent in 2007 to 36.8 percent of visits in 2014 (p = 0.027). Hydromorphone accounted for a greater proportion of opioids administered by the end of the study period, compared to other opioids. Patient characteristics associated with hydromorphone were age <65 years, white race, private insurance or Medicare, and severe pain. Patients who received hydromorphone also had indicators of higher severity illness, including more laboratory testing, procedures, and higher admission rates. Common conditions where hydromorphone was administered were headache, back pain, musculoskeletal pain, and abdominal pain. CONCLUSION: From 2007 to 2014, hydromorphone was administered to more than one in three US ED patients who were administered opioids, and several factors predicted its use. High use was found in some conditions where opioid use is inappropriate, suggesting a need for additional initiatives to promote rational prescribing of high-potency opioids. SN - 1551-7489 UR - https://www.unboundmedicine.com/medline/citation/30234923/Trends_in_and_predictors_of_hydromorphone_administration_in_US_emergency_departments__2007_2014__ DB - PRIME DP - Unbound Medicine ER -