Development of an algorithm to identify serious opioid toxicity in children

BMC Research Notes

Wayne A Ray³  C Michael Stein¹  Judith A Dudley³  Kathi Hall³  Katherine T Murray¹  William O Cooper²  S Todd Callahan²  Cecilia P Chung¹ 

[1] Division of Rheumatology, Department of Medicine, Vanderbilt University School of Medicine, T-3113 MCN, 1161 21st Ave. S., Nashville 37232, TN, USA;Department of Pediatrics, Vanderbilt University School of Medicine, Nashville 37232, TN, USA;Department of Health Policy, Vanderbilt University School of Medicine, Nashville 37232, TN, USA

关键词: Algorithm;    Validation;    Children;    Toxicity;    Poisoning;    Opioid;   

Others  :  1231581
DOI  :  10.1186/s13104-015-1185-x

 received in 2015-01-05, accepted in 2015-05-20,  发布年份 2015

【 摘 要 】

Background

The use of opioids is increasing in children; therefore, opioid toxicity could be a public health problem in this vulnerable population. However, we are not aware of a published algorithm to identify cases of opioid toxicity in children using administrative databases. We sought to develop an algorithm to identify them. After review of literature and de-identified computer profiles, a broad set of ICD-9 CM codes consistent with serious opioid toxicity was selected. Based on these codes, we identified 195 potential cases of opioid toxicity in children enrolled in Tennessee Medicaid. Medical records were independently reviewed by two physicians; episodes considered equivocal were reviewed by an adjudication committee. Cases were adjudicated as Group 1 (definite/probable), Group 2 (possible), or Group 3 (excluded).

Results

Of the 195 potential cases, 168 (86.2%) had complete records for review and 85 were confirmed cases. The overall positive predictive value (PPV) for all codes was 50.6%. The PPV for codes indicating: unintentional opioid overdose (25/31) was 80.7%; intentional opioid overdose (15/30) was 50.0%, adverse events (33/58) was 56.9%, the presence of signs or symptoms compatible with opioid toxicity (12/47) was 25.5%, and no cases were confirmed in records from the two deaths. Of the confirmed cases, 65.8% were related to therapeutic opioid use.

Conclusion

For studies utilizing administrative claims to quantify incidence of opioid toxicity in children, our findings suggest that use of a broad set of screening codes coupled with medical record review is important to increase the completeness of case ascertainment.

【 授权许可】

   
2015 Chung et al.

【 图 表 】

Figure1.

【 参考文献 】

• [1]Okie S: A flood of opioids, a rising tide of deaths. N Engl J Med 2010, 363(21):1981-1985.
• [2]Kuehn BM: Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA 2007, 297(3):249-251.
• [3]Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al.: Opioid prescriptions for chronic pain and overdose. Ann Intern Med 2010, 152(2):85-92.
• [4]Centers for Disease Control and Prevention (2011) Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 60:1487–1492
• [5]Takata GS, Mason W, Taketomo C, Logsdon T, Sharek PJ: Development, testing, and findings of a pediatric-focused trigger tool to identify medication-related harm in US children’s hospitals. Pediatrics 2008, 121(4):e927-e935.
• [6]Ferreirós N, Dresen S, Hermanns-Clausen M, Auwaerter V, Thierauf A, Müller C, et al.: Fatal and severe codeine intoxication in 3-year-old twins—interpretation of drug and metabolite concentrations. Int J Legal Med 2009, 123(5):387-394.
• [7]Madadi P, Hildebrandt D, Gong IY, Schwarz UI, Ciszkowski C, Ross CJ, et al.: Fatal hydrocodone overdose in a child: pharmacogenetics and drug interactions. Pediatrics 2010, 126(4):e986-e989.
• [8]Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS: Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics 2010, 126(6):1108-1116.
• [9]Landen MG, Castle S, Nolte KB, Gonzales M, Escobedo LG, Chatterjee BF, et al.: Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico. Am J Epidemiol 2003, 157(3):273-278.
• [10]de Wildt SN, Tibboel D, Leeder JS: Drug metabolism for the paediatrician. Arch Dis Child 2014, 99(12):1137-1142.
• [11]Ray WA, Griffin MR: Use of Medicaid data for pharmacoepidemiology. Am J Epidemiol 1989, 129(4):837-849.
• [12]Boyer EW: Management of opioid analgesic overdose. N Engl J Med 2012, 367(2):146-155.
• [13]Hayes BD, Klein-Schwartz W, Doyon S: Toxicity of buprenorphine overdoses in children. Pediatrics 2008, 121(4):e782-e786.
• [14]Sachdeva DK, Stadnyk JM: Are one or two dangerous? Opioid exposure in toddlers. J Emerg Med 2005, 29(1):77-84.
• [15]Boyer EW, McCance-Katz EF, Marcus S: Methadone and buprenorphine toxicity in children. Am J Addict 2010, 19(1):89-95.
• [16]Kyff JV, Rice TL: Meperidine-associated seizures in a child. Clin Pharm 1990, 9(5):337-338.
• [17]Kramer MS: Difficulties in assessing the adverse effects of drugs. Br J Clin Pharmacol 1981, 11(Suppl 1):105S-110S.
• [18]Viera AJ, Garrett JM: Understanding interobserver agreement: the kappa statistic. Fam Med 2005, 37(5):360-363.