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Patterns of Medication Administration From 2001 to 2009 in the Treatment of Children With Acute Burn Injuries: A Multicenter Study

Stoddard, Frederick J. Jr*†; White, Gwyne W. BA*†; Kazis, Lewis E. ScD*‡; Murphy, J. Michael EdD*†; Sorrentino, Erica A. MA*†; Hinson, Michelle RN*; Kim Stubbs, Teresa RN§; Chan, Grace RN; Sheridan, Robert L. MD*†; Palmieri, Tina MD; Kagan, Richard MD§; Herndon, David MD; Tompkins, Ronald G. MD, ScD*†

doi: 10.1097/BCR.0b013e31822bef92
Original Articles

Children with burn injuries receive a broad range of medications, from analgesics to antipsychotics, but how utilization of these drugs differs from one pediatric burn center to another is unclear. This study examined utilization patterns of six categories of medication administered acutely to burned children as a first step in creating evidence-based practice guidelines. Six medications administered to pediatric patients enrolled in a multicenter study were recorded from patient charts using a standardized chart review template. The medication categories included opiates, benzodiazepines, antidepressants, beta-blockers, two different anesthetics, and antipsychotics. Data were analyzed by χ2 and logistical regression analysis. Analysis of data from three sites and 470 patients revealed significant differences in prescription patterns across hospitals for all medication groups except opiates. Differences were significant for benzodiazepines and antidepressants (χ2 = 7.3; P < .01 for both) controlling for age, gender, race, language, burn size, and length of stay. Differences in prescribing patterns for beta-blockers and the anesthetics ketamine and propofol failed to reach statistical significance; however, the results did trend in that direction (χ2 = 3.8 and 3.4, respectively; P < .10 for both). The pharmacotherapeutic agents described in this study are an integral part of acute pediatric burn care, and yet there is variation in use of these medications among the centers. The differences in prescribing indicate that, for certain drugs, a range of approaches to pharmacotherapeutics is being used and suggest that evidence-based guidelines for administration of these agents need to be developed.

From the *Shriners Hospitals for Children-Boston, Massachusetts; †Harvard Medical School at Massachusetts General Hospital, Boston; ‡Center for Assessment of Pharmaceutical Practices (CAPP), Boston University School of Public Health, Massachusetts; §Shriners Hospitals for Children-Cincinnati, Ohio; ∥Shriners Hospitals for Children-Northern California, Sacramento; and ¶Shriners Hospitals for Children-Galveston, Texas.

Supported by Grant # 9157 from the Shriners Hospitals for Children.

Principal investigator: Ronald G. Tompkins, Shriners Hospitals for Children-Boston, Boston, MA. Clinical co-investigators: Patricia Blakeney, Shriners Hospitals for Children-Galveston, Galveston, TX; David Herndon, Shriners Hospitals for Children-Galveston, Galveston, TX; Richard Kagan, Shriners Hospitals for Children-Cincinnati, Cincinnati, OH; Robert L. Sheridan, Shriners Hospital for Children Boston, MA; Walter Meyer III, Shriners Hospitals for Children-Galveston, Galveston, TX; Tina Palmieri, Shriners Hospitals for Children-Northern California, Sacramento, CA. Research co-investigators: Kathleen Carey, Boston University School of Public Health, Boston, MA; Austin Lee, Shriners Hospitals for Children, Boston, MA; Matthew Liang, Brigham and Women's Hospitals and Veterans Administration; Nien-Chen Li, Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA; J. Michael Murphy, Shriners Hospitals for Children-Boston, Boston, MA; Frederick J. Stoddard Jr., Shriners Hospitals for Children-Boston, Boston, MA; Petra Warner, Shriners Hospitals for Children-Cincinnati, Cincinnati, OH. Other clinical/research participants: Catherine Calvert, N. Carolina Jaycee Burn Center, Chapel Hill, NC; Marc Cullen, Detroit Children's Hospital, Detroit, MI; Lawren Daltroy (deceased), Mary Beth Daugherty, Shriners Hospitals for Children-Cincinnati, OH; Sylvia Garma, University of CA at Davis, Sacramento, CA; Cleon Goodwin, Western States Burn Center, Greeley, CO; Marilyn Jenkins (deceased), Shriners Hospitals for Children-Cincinnati, Cincinnati, OH; Martha Lydon, Shriners Hospitals for Children-Boston, Boston, MA; Robert McCauley, Shriners Hospitals for Children-Galveston, Galveston, TX; Andrew Munster (deceased), William Tunell (retired), Oklahoma City, OK; Glenn Warden, Shriners Hospitals for Children-Cincinnati, Cincinnati, OH; David Wood, Department of Health-Pediatrics, Jacksonville, FL. Study coordinators: Grace Chan, Shriners Hospitals for Children-Northern California, Sacramento, CA; Kathryn Epperson, Shriners Hospitals for Children-Galveston, Galveston, TX; Michelle Hinson, Shriners Hospitals for Children-Boston, Boston, MA; Karen Lenkus, Shriners Hospitals for Children-Northern California, Sacramento, CA; Janet Gilroy-Lewis, Shriners Hospitals for Children-Boston, Boston, MA; Kate Nelson Mooney, Shriners Hospitals for Children-Northern California, Sacramento, CA; Marc Nicolai, Shriners Hospitals for Children-Galveston, Galveston, TX; Mary Rose, University of Texas Medical Branch, Galveston, TX; Johanna Sanders, Shriners Hospitals for Children-Northern California, Sacramento, CA; Kim Stubbs, Shriners Hospitals for Children-Cincinnati, Cincinnati, OH. Data managers: Helena Bauk, Shriners Hospitals for Children-Boston, Boston, MA; Kimberly Cantu, Shriners Hospitals for Children-Galveston, TX; Christine Duval, Shriners Hospitals for Children-Galveston, TX; Kathy Korte, Shriners Hospitals for Children-Cincinnati, Cincinnati, OH. Analysts: Ruzan Avetisyan, Boston University School of Public Health, Boston, MA; Jing Deng, Boston University School of Public Health, Boston, MA; Nien Chen Li, Boston University, Boston, MA; Lingwei (Adam) Meng, Boston University, Boston, MA; Xiaokai, Boston University, Boston, MA; Gabe D. Shapiro, Boston University School of Public Health, Boston, MA; Xinhua S. Ren, Boston University School of Public Health, Boston, MA; Stanley Wang, Boston University School of Public Health, Boston, MA; Chen (Kerryn) Yang, Boston University, Boston, MA; Mengyao (Zoe) Zhao, Boston University School of Public Health, Boston, MA; Zhengping Zhong, Boston University, Boston, MA. Study staff: Eileen Evans, Boston University School of Public Health, Boston, MA; Kelly M. Jarrett, Boston University School of Public Health, Boston, MA; Charlotte Phillips, NE Baptist Hospital, Boston, MA.

Address correspondence to Dr. Frederick J. Stoddard, Jr, SBH 610, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

© 2011 The American Burn Association