儿童急诊科阿片类药物成瘾青少年的治疗和转诊:一项试点研究

IF 2.8 3区 医学 Q1 PEDIATRICS
Gabriel Devlin, Neri Bernabe, Irene Lim, Alan L Nager
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引用次数: 0

摘要

背景:致死性阿片类药物过量在青少年中有所增加。急诊科(ed)是连接成人阿片类药物使用障碍(OUD)与药物辅助治疗(MAT)的关键接入点。这在儿科患者中是否可行尚不清楚。由于青少年使用阿片类药物会导致发病率和死亡率,因此制定阿片类药物治疗方案至关重要。方法:根据专家意见制定ED丁丙诺啡诱导转诊方案。所有患者均完成急诊科窘迫反应筛选(ED-DRS)和筛选到短暂干预(S2BI)工具。在13个月的试验期后,我们根据执行程度、保真度和资源利用率进行了回顾性图表审查,以评估该计划的可行性。结果:我们确定了12例因阿片类药物戒断而遭遇ED的患者接受丁丙诺啡治疗。75%的人年龄在15-17岁之间。75%的患者表现为轻度戒断,25%表现为中度戒断。参与者报告抑郁(80%)、焦虑(90%)和额外药物使用(90%)的比例很高。75%的病人在急诊科只需要一剂丁丙诺啡来治疗戒断。没有任何医疗并发症。虽然我们将100%的患者转介到OUD治疗中心,但只有50%的患者第一次就诊,42%的患者在30天后仍未出院。患者、家长和保险等因素共同导致了患者参与度的下降。结论:儿童ed丁丙诺啡诱导稳定青少年急性阿片类药物戒断症状是可行的,且不会引起并发症。需要进一步的数据来确定青少年在出院后面临的OUD参与障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treatment and Referral of Youth with Opioid Addiction in the Pediatric Emergency Department: A Pilot Study.

Background: Fatal opioid overdoses have increased among adolescents. Emergency Departments (EDs) are critical access points for connecting adults with opioid use disorder (OUD) to medication-assisted treatment (MAT). Whether this is feasible in pediatric patients is unknown. As opioid use among adolescents results in morbidity and mortality, developing an opioid treatment program is crucial.

Methods: We developed an ED buprenorphine induction and referral program based on expert opinion. All patients completed the Emergency Department Distress Response Screener (ED-DRS) and Screening to Brief Intervention (S2BI) tools. After a 13-month pilot period, we performed a retrospective chart review to assess the program's feasibility based on the degree of execution, fidelity, and resource utilization.

Results: We identified 12 ED encounters for opioid withdrawal that received buprenorphine. 75% were aged 15-17 years. 75% of encounters presented with mild withdrawal, while 25% presented with moderate withdrawal. Participants reported high rates of depression (80%), anxiety (90%), and additional substance use (90%). 75% of encounters only required 1 dose of buprenorphine in the ED to treat their withdrawal. There were no medical complications. Although we referred 100% of encounters to an OUD treatment center, only 50% attended their first appointment, and 42% remained engaged after 30 days. A mix of patient, parent, and insurance factors contributed to loss of engagement.

Conclusions: Pediatric ED-based buprenorphine induction is feasible for the stabilization of acute opioid withdrawal symptoms in youth without causing complications. Further data is necessary to determine the barriers adolescents face to OUD engagement after discharge.

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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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