{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:50:39Z","timestamp":1779299439758,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Treatment of postoperative pain for children with severe neurologic impairment (SNI) is challenging. We describe the type, number of classes, and duration of postoperative pain medications for procedures common among children with SNI, as well as the variability across children's hospitals in pain management with an emphasis on opioid prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included children with SNI ages 0\u201321 years old who underwent common procedures between January 1, 2019 and December 31, 2019 within 49 children's hospitals in the Pediatric Health Information System. We defined SNI using previously described high\u2010intensity neurologic impairment diagnosis codes and identified six common procedures which included fracture treatment, tracheostomy, spinal fusion, ventriculoperitoneal shunt placement (VP shunt), colostomy, or heart valve repair. Medication classes included benzodiazepines, opioids, and other nonopioid pain medications. Acetaminophen and nonsteroidal anti\u2010inflammatory drugs were excluded from analysis. All findings were summarized using bivariate statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7184 children with SNI underwent a procedure of interest. The median number of classes of pain medications administered varied by procedure (e.g., VP shunt: 0 (interquartile range [IQR] 0\u20131); tracheostomy: 3 (IQR 2\u20134)). Across all procedures, opioids and benzodiazepines were the most commonly prescribed pain medications (48.8% and 38.7%, respectively). We observed significant variability in the percentage of postoperative days with opioids across hospitals by procedure (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is substantial variability in the postoperative delivery of pain medications for children with SNI. A standardized approach may decrease the variability in postoperative pain control and enhance care for children with SNI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.13539","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:48:28Z","timestamp":1729817308000},"page":"446-453","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Variability in treatment of postoperative pain in children with severe neurologic impairment"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5972-8503","authenticated-orcid":false,"given":"Jordan","family":"Keys","sequence":"first","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1616-7721","authenticated-orcid":false,"given":"Jessica L.","family":"Markham","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-5887","authenticated-orcid":false,"given":"Matthew","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"},{"name":"Children's Hospital Association Lenexa Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2980-1165","authenticated-orcid":false,"given":"Emily J.","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Linebarger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Bettenhausen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001158"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3021"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13030401"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0175"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2020.09.001"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-022-03632-4"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2019.2672"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7489(02)00058-5"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000822"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2011.05.009"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200203000-00004"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/children5010013"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000822"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000287680.21212.d0"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-1002"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.1531"},{"key":"e_1_2_10_18_1","unstructured":"Agency for Healthcare Research & Quality. Clinical Classifications Software (CCS) for ICD\u201010\u2010PCS. Accessed May 20 2024.https:\/\/hcup-us.ahrq.gov\/toolssoftware\/ccs10\/ccs10.jsp"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-199"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.2948"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.03.074"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.1531"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2001.00686.x"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jspn.12069"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2002.02206.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1059840517722591"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.85.6.460"},{"issue":"6","key":"e_1_2_10_28_1","article-title":"As required versus fixed schedule analgesic administration for postoperative pain in children","volume":"2020","author":"Erskine A","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-023-00526-w"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2023.06.007"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-018-3237-4"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.157.12.1219"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-019-00264-0"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2020.110251"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-012-1720-x"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68700-X"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/908061"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.3928\/00904481-20100318-04"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40272-020-00423-1"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-020-02767-x"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.13539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:50:33Z","timestamp":1764597033000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.13539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/jhm.13539"],"URL":"https:\/\/doi.org\/10.1002\/jhm.13539","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]},"assertion":[{"value":"2024-06-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}