Uncomplicated Distal Radius Fractures: An Opportunity to Reduce Emergency Medicine Opioid Prescribing?

Abstract

Objectives: To assess emergency physician prescribing for simple extremity fractures-specifically, distal radius fractures-and describe the opportunity for reducing opioid prescribing.Methods: An electronic survey was distributed to 1238 emergency physicians employed by a nationwide practice serving 220 sites in 20 states. The survey presented two plain film views of a simple Colles fracture and asked: "For the last patient you discharged . . . with the above injury, which pain medications did you prescribe or recommend?" Responses were collected using a clickable checklist of common opioid and nonopioid pain medications. Respondents also specified the number of days covered by any prescription. We assessed associations between physician characteristics and opioid prescribing using the χ 2 test, the Wilcoxon ranksum test, and multivariable regression models.Results: Responses were received from 447 (36%) physicians working in 18 states; 93% were trained in emergency medicine, 33% worked at academic sites, 68% had site volumes between 25,000 and 75,000, and the median experience was 10 (interquartile range 5-19) years. Overall, 92% (95% confidence interval 89%-95%) had prescribed an opioid for a median of 3 (interquartile range 3-4) days. The most commonly prescribed opioids were hydrocodone/acetaminophen (55%) and oxycodone/ acetaminophen (20%). Physicians at academic sites prescribed opioids less frequently than those at nonacademic sites (88% vs 94%), but in multivariable regression there were no significant associations between physician characteristics and opioid prescribing.Conclusions: Emergency physicians commonly prescribe opioids for simple distal radius fractures. This represents a potential opportunity to reduce opioid prescribing.

Guidelines Could Reduce Opioid Prescribing for Uncomplicated Distal Radius Fractures

“…by Altman et al was highly informative. 1 The authors sent a survey to 1238 emergency physicians across the nation, asking for the type and dose of pain medication they prescribed to their last patient who had a distal radial fracture. They found that approximately 92% of the surveyed emergency physicians prescribed, on average, a 3-day supply of opioids.…”

“…In summary, we applaud Dr Altman and the research team for underscoring the need and opportunity to reduce the number of opioids prescribed for distal radius fractures. 1 In a continuation of their work, we would encourage them to create a recommendation card that specifically outlines the optimal doses of opioids and nonopioid pain medication that should be prescribed for various types of fractures among adult and pediatric patient populations.…”

“…The article entitled "Uncomplicated Distal Radius Fractures: An Opportunity to Reduce Emergency Medicine Opioid Prescribing?" by Altman et al was highly informative 1 . The authors sent a survey to 1238 emergency physicians across the nation, asking for the type and dose of pain medication they prescribed to their last patient who had a distal radial fracture.…”