School of Medicine and Health Sciences Poster Presentations

Title

Emergency Department Opioid Prescriptions for Shoulder Dislocations 2005-2015

Document Type

Poster

Status

Medical Student

Abstract Category

Drug Abuse

Keywords

opioids, dislocations, emergency

Publication Date

Spring 2018

Abstract

Introduction/Background Shoulder dislocations are frequently related to sports and outdoor activities. Many reduction techniques for simple anterior shoulder dislocations can be successfully performed in the field with simple or no analgesics. Despite this, many patients in U.S. EDs continue to be treated with opioid analgesics. To assess this, we performed an analysis of the medication administration dynamics of closed shoulder dislocations in U.S. EDs.

Objective To analyze dynamics and trends in medication administration for closed shoulder dislocations in U.S. EDs Methods We analyzed shoulder dislocation ICD codes from the CDC’s 2005-2015 National Hospital Ambulatory Medical Care Survey, determined the medications prescribed, and subsequently applied appropriate statistical analyses.

Results Patients with closed shoulder dislocations of any type totaled over 2 million between 2005-2015. The majority, 71.1% (95% CI 64.7-76.7, p<0.0001), received opioids while in the ED, with 47.4% (95% CI 41.4-53.4, p<0.0001) receiving an opioid as their first medication and 33.9% (95% CI 28.6-39.8, p<0.0001) receiving opioids as a prescription at discharge. Concurrently, 38.6% (95% CI 32.8-44.8, p<0.0001) of patients were administered NSAIDS in the ED, 11.4% received muscle relaxers (95% CI 8.32-15.31, p<0.0001) and 3.3% (95% CI 1.6-4.66, p<0.0001) received lidocaine injections. Between 2005-2015, the administration of opioids experienced a relative change overall of -10.2%, excepting hydromorphone and fentanyl, which increased 14.6% and 12.2%, respectively.

Conclusions Most patients presenting to EDs with shoulder dislocations received opioids in some form. NSAIDs, muscle relaxers and lidocaine injections were comparatively underutilized. We conclude that shoulder dislocations are a significant source of opioid overprescription. Providers should feel comfortable reducing shoulder dislocation without the use of opioids.

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Emergency Department Opioid Prescriptions for Shoulder Dislocations 2005-2015

Introduction/Background Shoulder dislocations are frequently related to sports and outdoor activities. Many reduction techniques for simple anterior shoulder dislocations can be successfully performed in the field with simple or no analgesics. Despite this, many patients in U.S. EDs continue to be treated with opioid analgesics. To assess this, we performed an analysis of the medication administration dynamics of closed shoulder dislocations in U.S. EDs.

Objective To analyze dynamics and trends in medication administration for closed shoulder dislocations in U.S. EDs Methods We analyzed shoulder dislocation ICD codes from the CDC’s 2005-2015 National Hospital Ambulatory Medical Care Survey, determined the medications prescribed, and subsequently applied appropriate statistical analyses.

Results Patients with closed shoulder dislocations of any type totaled over 2 million between 2005-2015. The majority, 71.1% (95% CI 64.7-76.7, p<0.0001), received opioids while in the ED, with 47.4% (95% CI 41.4-53.4, p<0.0001) receiving an opioid as their first medication and 33.9% (95% CI 28.6-39.8, p<0.0001) receiving opioids as a prescription at discharge. Concurrently, 38.6% (95% CI 32.8-44.8, p<0.0001) of patients were administered NSAIDS in the ED, 11.4% received muscle relaxers (95% CI 8.32-15.31, p<0.0001) and 3.3% (95% CI 1.6-4.66, p<0.0001) received lidocaine injections. Between 2005-2015, the administration of opioids experienced a relative change overall of -10.2%, excepting hydromorphone and fentanyl, which increased 14.6% and 12.2%, respectively.

Conclusions Most patients presenting to EDs with shoulder dislocations received opioids in some form. NSAIDs, muscle relaxers and lidocaine injections were comparatively underutilized. We conclude that shoulder dislocations are a significant source of opioid overprescription. Providers should feel comfortable reducing shoulder dislocation without the use of opioids.