Abstract
Introduction
Childhood burns are extremely common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, disrupting care and increasing the risk of post-traumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of burns in pediatric patients. We sought to evaluate the current use of multimodal therapy as well as the use, storage, and disposal of opioids in this patient population.
Methods
We prospectively surveyed parents of pediatric burn patients (0–18 years old) who presented to the burn clinic within two weeks of burn injury. Parents were surveyed regarding over-the-counter pain medication use and opioid medication use, storage, and disposal in the treatment of their child. Medians and interquartile ranges were used to describe continuous variables and frequencies and percentages were used for categorical variables.
Results
A total of 92 parents of burn-injured children were surveyed at a single institution in the outpatient burn clinic. The median age of burn-injured children was 3.1 years old, and 50% of patients were male. The majority had a TBSA of 1%. The hand was the most frequently burned location (45.7%). Acetaminophen (58.7%) and ibuprofen (69.6%) were the most common treatments for both constant and breakthrough pain.
Approximately 28% (26/92) of patients were prescribed opioids, of which 18.5% (17/92) filled their prescription. Only 29% of patients (5/17) consumed their entire prescription, and a median of 3 doses of opioids remained for those who did not finish the entire prescription. Parents most commonly decided to give their children opioid pain medications because “my child is in severe pain” or “I give my child pain medications as scheduled (written on prescription).” Approximately 40% (7/17) of patients who filled opioid prescriptions stored them in a locked area, and only 35.3% (6/17) were educated on how to dispose of excess opioid pain medication.
Conclusions
Presently, multimodal therapy with over-the-counter pain medications is used to treat the majority of pediatric burns. This study demonstrates an increased need for education on opioid administration, storage, and disposal for parents of burn-injured children.
Applicability of Research to Practice
We aimed to evaluate what current trends in opioid use are in pediatric burn patients and areas for improvement in parent education for over-the-counter pain medication use, opioid use, opioid storage, and disposal. From the study, we were able to glean that the majority of patients are successfully managed with over-the-counter pain medications. However, parents and patients managed with opioids need additional education on appropriate administration of opioid pain medications, safe locked storage of opioids, and opioid disposal. This demonstrates an area for quality improvement inpatient and outpatient.