(1487) Challenging the Standard of Opioid Withdrawal Screening for Pediatric Critical Care: A Cohort Study

Introduction: Opioids are the cornerstone of sedation and analgesia in critically ill patients. Prolonged use is associated with withdrawal, added morbidity, and prolonged length of stay. In pediatrics, the Withdrawal Assessment Tool (WAT-1) is used for early detection of Iatrogenic Withdrawal Syndromes (IWS). However, WAT-1 was primarily validated in younger patients and does not account for the individual’s chronological and developmental age. This study aims to assess if an adult IWS screening tool, the Clinical Opiate Withdrawal Score (COWS), is more sensitive in an adolescent population.

Methods: This is a prospective observational cohort study comparing the sensitivity of WAT-1 and COWS in adolescent patients by diagnosis of IWS using DSM-5. Patients meeting inclusion criteria were screened daily for IWS when total opioid dose was weaned with the goal to liberate from sedation. Patients were screened every 24 hours for 7 days or until the patient was transferred out of the PICU. Data collection included demographics, clinical presentation, co-morbid conditions, opioid use, and detection rate of IWS. All opioid infusions were converted to morphine equivalent.

Results: Over a 5-month period, 10 patients met inclusion criteria of age ≥ 10 years and exposure to opioid infusion for ≥ 2 days. 60% of the cohort were male, with a median age of 15.5 years (IQR±2), admitted for acute respiratory failure (60%). Median opioid infusion duration was 6.5 days (IQR±6), with a maximum infusion morphine dose of 11.65 (IQR±11.45) (mg/hr). Based on 47 screenings of IWS, sensitivity for COWS was 0.92 (CI 0.74-0.99) compared to WAT-1 0.24 (CI 0.094-0.451). Our study indicates that COWS has significantly higher sensitivity in screening IWS than WAT-1 in adolescent patients.

Conclusions: WAT-1 is an easily accessible tool to screen for IWS by the bedside providers. However, this was not validated in patients over 10 years of age. In our novel research, our early data suggests that COWS is a more sensitive screening tool for IWS in adolescent patients, challenging our current practice of using WAT-1 for all critically ill patients in the PICU. Pediatric patients encompass a wide range of developmental ages, and this study highlights the need for age specific tools for our patient population.