Pediatric Chronic Pain Admissions Rise 831% in 7 Years

Larry Hand

July 03, 2013

The number of pediatric patients admitted to US hospitals with chronic pain diagnoses increased by 831% from 2004 to 2010. The average patient was a white girl about 14 years old with headaches, abdominal and musculoskeletal pain, and depression and anxiety, according to a study published online July 1 in Pediatrics.

Thomas A. Coffelt, MD, from the Department of Pediatrics at Indiana University School of Medicine, Indianapolis, and colleagues analyzed the de-identified records of 3752 pediatric patients up to 18 years old who were admitted for chronic pain between January 1, 2004, and December 31, 2010. The number represented 0.16% of the overall patient population in the Pediatric Health Information System, a database that contains information from 43 not-for-profit pediatric hospitals across the United States.

The researchers used several International Classification of Disease, Ninth Revision (ICD-9), codes to include in their analysis. They excluded patients with diagnoses of cancer, sickle cell disease, burns, and cerebral palsy, as well as ventilator-dependent and neonatal intensive care patients.

Only 235 of the 3752 patients were aged 0 to 7 years. Girls outnumbered boys by 2.41 to 1, and whites accounted for 79% of the study population.

Half of the patients were admitted from the emergency department into the hospital for chronic pain diagnoses, with a mean total of 10 secondary diagnoses per patient. The most common comorbidities were abdominal pain (39% of patients), mood disorders (28%), constipation (20%), nausea/vomiting/diarrhea (18%), anxiety and panic disorders (18%), and headaches (18%).

Of all patients, 65% had gastrointestinal diagnoses, 44% had psychiatric diagnoses, and 9.9% had a coded medication adverse effect, overdose, or substance abuse. Adverse effects of opiates were most common, at 1.4%. Some records also indicated a history of physical/psychological/sexual abuse and psychiatric conditions.

The mean length of stay for all patients came to 7.32 days, although the expected length of stay was 4.24 days, and 12.5% were readmitted within a year of their initial discharge (2.6% more than once).

Chronic pain patients underwent a mean of 3.18 procedures per patient, with the most common being esophagogastroduodenoscopy. Pediatrics was the most common attending specialty, followed by gastroenterology and anesthesiology.

Chronic pain pediatric admissions increased from 143 in 2004 to 1188 in 2010, for an increase of 831%.

Limitations of the study include limitations in ICD-9 codes related to chronic pain, including no code for fibromyalgia, which could have led to confusion about what is a primary condition and what is a comorbid condition. In addition, not all hospitals submit all of the data elements examined in the study, which led to the exclusion of patients with missing data from some analyses.

However, the researchers write, this study documents for the first time for the pediatric population that readmission rates are substantial and that many patients undergo invasive procedures either diagnostically or therapeutically.

"Clearly," the researchers write, "more information is needed on the underlying pathologic and social mechanisms that contribute to these patients' symptoms so that we can develop treatments targeted to those mechanisms rather than use reactive symptomatic therapies such as opiates and benzodiazepines, which often have addictive potential and a tendency for adverse effects."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 1, 2013. Abstract


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