COMMENTARY

Opioid Ingestion in Kids: The Huge Increase in ICU Admissions

William T. Basco, Jr., MD, MS

Disclosures

August 27, 2018

Pediatric Hospitalization After Opioid Exposure

Studies have shown increases in hospitalization of children after opioid exposure,[1] but less is known about whether those children require intensive care. A recent study[2] utilized data from 31 of the 49 hospitals that contribute to the Pediatric Health Information System to identify opioid-related admissions to pediatric hospitals and pediatric intensive care units (PICUs) of children aged 1-17 years, from 2004 to 2015.

One finding that bears repeating is the increase and relatively high contribution of methadone exposure among young children.

The sample included 3647 children, comprising 0.9% of all admissions to the contributing hospitals during that period. This correlates to 8.7 opioid-related admissions per 10,000 admissions over the study years. This rate increased from 6.7/10,000 in 2004-2007 to 10.9/10,000 in 2012-2015. Slightly more than one third (34.2%) of all the admissions were among children aged 1-5 years, and 19.5% of those were for methadone ingestion.

Among the 3647 children admitted for opioid exposure, 1564 (43%) were admitted to the PICU for a rate of 31.2 children/10,000 PICU admissions, increasing by 35% over the study years. Of those admitted to the PICU, 37% required ventilator support and 1.6% died. The cost of PICU care averaged $4,931 per admission. The investigators concluded that the US opioid crisis is associated with increases in opioid-related hospitalization and PICU admission among children.

Viewpoint

This study also received a great deal of lay press. An increase in pediatric intensive care admissions following opioid use or exposure probably doesn't surprise many people, but I doubt many would have guessed a 47% increase! One finding that bears repeating is the increase and relatively high contribution of methadone exposure among young children. In a recent viewpoint about exposure to medications for attention-deficit/hyperactivity disorder, I reviewed the need for proper medication storage, something that pediatric providers can't emphasize enough. This study illustrates the need once again.

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