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Background: The assessment of pain in children with severe neurologic impairment (SNI) can be more challenging than in neurotypical children.

Objective: To describe the type, number of classes, and duration of post-operative pain medications for procedures common among children with SNI. Secondarily, to describe the variability in pain management strategies across children’s hospitals, specifically for opioid administration.

Design/Methods: This retrospective cohort study of the Pediatric Health Information System included children hospitalized with SNI aged 0-21 years old who underwent common procedures during 2019. We defined SNI using previously described high-intensity neurologic impairment (HINI) diagnosis codes and identified six common (>500 encounters) procedures among our population (e.g., fracture treatment, tracheostomy, spinal fusion, ventriculoperitoneal shunt placement (VP shunt), colostomy, or heart valve repair) using the clinical classifications software (CCS). Clinical and demographic information were summarized using bivariate statistics. Children excluded from this cohort did not undergo any of the six preselected procedures, had multiple procedures performed, or received an organ transplant. Medication classes were defined using the Classification of Palliative Care Pain Medications. Non-opioid medications were excluded from analysis to hone in on opioid administration.

Results: The cohort consisted of 7180 children; 65.9% had 1 HINI diagnosis, and 12.0% had 3+ HINI diagnoses. The proportion of post-operative days with pain medications ranged from the least 28.8% (VP shunt) to the most 71.7% (spinal fusion). The number of classes of pain medications ranged from the least 0-1 (VP shunt) to the most 2-4 (Tracheostomy, Table 2). We observed notable variability in the use of opioids across hospitals (0% to 100% overall, p<.001) and by procedure (Colostomies, Heart Valve Repair, Tracheostomies and VP Shunts at 0% to 100% for Spinal Fusion, Figure 1).

Conclusion: Children with SNI experienced variability in the type, number of classes, and duration of all pain medications delivered post-operatively. This included an inconsistent use of opioids based upon hospital and procedure. Our findings indicate the need for both a standardized approach to the assessment of pain and post-operative pain management for children with SNI.

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Presented at the 2023 Pediatric Academic Societies (PAS) Conference; Washington, D.C.; April 27-May 1, 2023.

Treatment of Post-Operative Pain in Children with Severe Neurological Impairment

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