儿童牙科中的高危药物:模式、结果和临床意义。

IF 3.5 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
Yilei Liu, Kawtar Zouaidi, Colin C Hubbard, Muhammad F Walji, Matthew R Cooke, Donald B Rindal, Kristin N Ray, Elsbeth Kalenderian, Katie J Suda
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引用次数: 0

摘要

背景:阿片类药物和苯二氮卓类药物等高危药物在儿童牙科护理中经常使用,但其处方模式和相关不良后果仍知之甚少。本研究的目的是确定此类处方对儿科患者的影响程度以及与不良后果相关的因素。方法:分析2014年至2019年18岁以下牙科就诊患者的MarketScan数据。高危药物包括苯二氮卓类药物、巴比妥类药物和阿片类药物。综合结果包括住院、急诊科就诊或牙科就诊后7天内的急诊就诊。阿片类药物归因结果包括7天内阿片类药物相关过量或访问后4至365天内持续使用阿片类药物。广义估计方程评估了结果与患者和就诊特征之间的关系。结果:在儿童牙科就诊中,0.72% (n = 269,991)涉及高危药物,4.3%经历复合结局。在9至11岁的患者(比值比[OR], 1.56)、男性患者(比值比,1.05)、患有复杂慢性疾病的患者(比值比,2.22)以及在医院或门诊手术环境中接受治疗的患者(比值比,2.20)中观察到较高的比值。在阿片类药物牙科就诊中,10.1%的患者有阿片类药物可归因的结果,其中4 - 5岁患者(OR, 1.48)、女性患者(OR, 1.08)、复杂慢性疾病患者(OR, 1.22)和门诊患者(OR, 1.43)的几率最高。结论:十分之一涉及阿片类药物的儿科牙科就诊与阿片类药物过量或持续使用有关,其中幼儿的比例最高。这些结果强调了在开具阿片类药物处方时需要谨慎,并为儿童提供基于指南的非阿片类药物镇痛。实际意义:通过指南依从性、非阿片类疼痛管理和提供者培训,促进更安全、公平的儿科牙科处方。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
High-risk medications in pediatric dentistry: Patterns, outcomes, and clinical implications.

Background: High-risk medications such as opioids and benzodiazepines are frequently prescribed in pediatric dental care, yet their prescribing patterns and associated adverse outcomes remain poorly understood. The aim of this study was to determine the extent of such prescribing to pediatric patients and factors associated with adverse outcomes.

Methods: MarketScan data for patients younger than 18 years with a dental visit from 2014 through 2019 were analyzed. High-risk medications included benzodiazepines, barbiturates, and opioids. Composite outcomes included hospitalization, emergency department visit, or urgent care visit within 7 days after the dental visit. Opioid-attributable outcomes included opioid-related overdose within 7 days or persistent opioid use 4 through 365 days after the visit. Generalized estimating equations assessed the association between outcomes and patient and visit characteristics.

Results: Among pediatric dental visits, 0.72% (n = 269,991) involved high-risk medications, with 4.3% experiencing a composite outcome. Higher odds were observed in ages 9 through 11 years (odds ratio [OR], 1.56), male patients (OR, 1.05), patients with complex chronic conditions (OR, 2.22), and care delivered in hospital or ambulatory surgery settings (OR, 2.20). Among dental visits with opioids, 10.1% had an opioid-attributable outcome, with the highest odds in patients 4 through 5 years (OR, 1.48), female patients (OR, 1.08), patients with complex chronic conditions (OR, 1.22), and care delivered in outpatient clinics (OR, 1.43).

Conclusions: One in 10 pediatric dental visits involving opioids was associated with opioid-related overdose or persistent use, with the highest odds in young children. These results highlight the need for caution in opioid prescribing and providing guideline-based nonopioid analgesia to children.

Practical implications: Promote safer, equitable pediatric dental prescribing through guideline adherence, nonopioid pain management, and provider training.

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来源期刊
Journal of the American Dental Association
Journal of the American Dental Association 医学-牙科与口腔外科
CiteScore
5.30
自引率
10.30%
发文量
221
审稿时长
34 days
期刊介绍: There is not a single source or solution to help dentists in their quest for lifelong learning, improving dental practice, and dental well-being. JADA+, along with The Journal of the American Dental Association, is striving to do just that, bringing together practical content covering dentistry topics and procedures to help dentists—both general dentists and specialists—provide better patient care and improve oral health and well-being. This is a work in progress; as we add more content, covering more topics of interest, it will continue to expand, becoming an ever-more essential source of oral health knowledge.
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