133 - Walk Down our Path: Assessing Initial Outcomes of an Inpatient Substance Withdrawal Pathway for Teens in a Children’s Hospital

Publication Number: 133.7031

Patricia N. Torres Rivera, Children’s Hospital of Philadelphia, Universidad Central del Caribe, Bayamón, Puerto Rico, United States; Maria Herrera, Yale School of Medicine, New Haven, CT, United States; Rachel Linstead, Poison Control Center at CHOP, Philadelphia, PA, United States; Jonathan Pletcher, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Krishna White, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Adolescents have a risk of developing a substance use disorder (SUD) due to developmental, biological, and social factors. In 2022, 48.7 million people aged 12 or older had a SUD, yet only 6% received treatment. Despite the recent recognition of SUDs as chronic relapsing brain diseases with adolescent onset, only a few children's hospitals offer withdrawal treatment.

Objective: The Inpatient Clinical Pathway for Adolescents with Suspected Substance Withdrawal addresses this gap by providing protocolized, evidenced-based care for adolescents experiencing withdrawal. This study aims to evaluate the initial outcomes of the pathway in identifying hospitalized teens at risk for withdrawal, standardizing care, and improving follow-up.

Design/Methods: Data were extracted from electronic health records at an urban academic and suburban campus of a children's hospital 6 months after pathway launch. The study included two groups: n=12 patients (mean age: 17 ± 2.4 years) who were on the pathway during an admission and a comparison group of n=211 patients (mean age: 17 ± 4.9 years) admitted for a substance use-related diagnosis before pathway implementation. Data collected included demographics, SUD diagnoses, comorbid conditions, length of stay (LOS), and readmission rates. Descriptive statistics and trend analysis were used to assess pathway effectiveness. A t-test was employed to compare the mean hospital LOS between the pre- and post-pathway implementation groups, and a chi-square test was utilized to compare follow-up completion rates.

Results: OUD was the most prevalent SUD diagnosis (n=7), followed by nicotine use disorder (n=6), cannabis use disorder (n=5), benzodiazepines use disorder (n=3), and alcohol use disorder (n=1). Five patients had polysubstance use. All patients had comorbid psychiatric and medical conditions, with depression (n=8) and general anxiety disorder (n=5) and chronic pain (n=5) the most common. Mean LOS decreased from 10.4 days in the pre-pathway implementation phase to 8.6 days in the post pathway phase, albeit this difference was not statistically significant. The pathway facilitated follow-up, increasing the percentage of patients completing follow up visits from 8.1% to 58.3% (p < 0.01).

Conclusion(s): The pathway standardized inpatient care for adolescents experiencing withdrawal, significantly improved outpatient follow-up rates, and potentially decreased LOS. The high prevalence of chronic pain and mental health comorbidities highlights the need for comprehensive discharge plans that incorporate physical, behavioral, and SUD treatment.