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Morphine Use in Pediatric Inpatients

Pediatric morphine use in the hospital

As with so many medications used widely to treat children, morphine is not labeled for pediatric use. Describing patterns of use helps us understand how many children are receiving a drug that is not approved for pediatric use by the FDA.

A statistical analysis of 877,201 pediatric hospitalizations in the United States in 2008 estimated that morphine was used in 54,613 (6.2%) hospitalizations in the database. If this percentage is applied to the total number of children’s hospitalizations in the US in 2008, as many as 476,205 children will have received morphine during their hospital stay that year. Fractures and appendicitis were two of the diagnoses most frequently listed for children receiving morphine.

While morphine can be used safely for pain management during hospital procedures, and has been used for this purpose for several decades, the lack of pediatric labeling is undesirable. In a discussion about whether the off-label use of a drug constitutes experimentation and research, the American Academy of Pediatrics Committee on Drugs noted that “discussion about the off-label status of a drug may, as a matter of professional judgment, be part of the information provided to the patient or parents.”

The article reporting statistical analysis on morphine use in pediatric inpatients can be found here:”Morphine Use in Hospitalized Children in the United States: A Descriptive Analysis of Data From Pediatric Hospitalizations in 2008″Lasky T, Greenspan J, Ernst FR, and Gonzalez L Clinical Therapeutics 2012, 34(3): pp.720-727.

The American Academy of Pediatrics discussion on “Uses of drugs not described in the package insert (off-label uses)” can be found here. Pediatrics. 2002;110: 181–183.

A Visual Medical Dictionary

With the Chi Visual Medical Dictionary, you can enter a disease or therapy and find all the terms it is related to, and retrieve a visualization of those relationships.  For example, this is the image retrieved using the term “epilepsy”.

Storytelling to Communicate Information and Motivate Patients

The New York Times (February 10, 2011) covered the report of a randomized clinical trial in Annals of Internal Medicine suggesting that a storytelling intervention produced substantial and significant improvements in blood pressure in African-Americans with uncontrolled hypertension. The intervention consisted of 3 DVDs containing patient stories, and blood pressure measurements were taken at 3, 6 and 9 months.

Link to NYTimes article.

Link to Annals article.

A Health Information Website Aimed at Children

The Great Ormond Street Hospital in England runs a website, Children First for Health. It has separate sections for Juniors (age 4 to 6), Kids (7 to 11) and Teens (12 to 18), as well as a section for parents.

The Body Tour lets kids click on a body part or bone and learn more about it.

Geographic Variation in Prescribing Practices

The authors used HEDIS quality measures, and mapped them by hospital referral region.

The map above shows variation in quality of prescribing high-risk drugs (medications considered to be high-risk for the elderly), and the map below shows variation in prescribing drugs with potentially harmful drug-disease interactions.

NEJM November 2010

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