Samuel J Zolin1, Vanessa P Ho2, Brian T Young2, Alexis R Harvey2, Kevin T Beel2, Esther S Tseng2, Laura R Brown2, Jeffrey A Claridge2. 1. Department of Surgery, Division of Trauma, Critical Care, Burns & Acute Care Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Cleveland Clinic Foundation, Digestive Disease Institute, Department of General Surgery, Cleveland, OH. Electronic address: zolins@ccf.org. 2. Department of Surgery, Division of Trauma, Critical Care, Burns & Acute Care Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Abstract
BACKGROUND: Opioid-prescribing practices for minimally injured trauma patients are unknown. We hypothesized that opioid-prescribing frequency and morphine-equivalent doses prescribed have decreased in recent years, specifically surrounding an acute prescribing limit implemented in August 2017 mandating opioid prescriptions not exceed 210 morphine-equivalent doses. METHODS: A single-center retrospective study was performed in the month of May during the years 2015 to 2018 on minimally injured trauma patients in a level I trauma center. Minimally injured trauma patients included patients discharged within 2 midnights of trauma evaluation without surgical intervention. Primary outcomes were discharge opioid-prescribing frequency and dosing in morphine-equivalent doses. Secondary outcomes were occurrence and timing of postdischarge follow-up. RESULTS: For 673 minimally injured trauma patients, opioid-prescribing frequency and morphine-equivalent doses prescribed decreased between 2015 and 2017 (49.3% to 31.5%, P = .006, mean 229 to 146 morphine-equivalent doses, P = .007). Decreases between 2017 and 2018 were not statistically significant. Acute prescribing limit compliance was 97% in 2018. After the acute prescribing limit was implemented, outpatient opioid prescribing did not increase and time to earliest follow-up did not decrease. CONCLUSION: Opioid-prescribing frequency and morphine-equivalent doses prescribed to minimally injured trauma patients decreased dramatically between 2015 and 2018. These changes occurred primarily before the implementation of an acute prescribing limit; however, incremental improvement and high compliance since implementation are demonstrated. Patients did not have significantly earlier follow-up encounters for pain or additional opioid prescriptions. Prospective research on pain control for minimally injured trauma patients is needed.
BACKGROUND: Opioid-prescribing practices for minimally injured traumapatients are unknown. We hypothesized that opioid-prescribing frequency and morphine-equivalent doses prescribed have decreased in recent years, specifically surrounding an acute prescribing limit implemented in August 2017 mandating opioid prescriptions not exceed 210 morphine-equivalent doses. METHODS: A single-center retrospective study was performed in the month of May during the years 2015 to 2018 on minimally injured traumapatients in a level I trauma center. Minimally injured traumapatients included patients discharged within 2 midnights of trauma evaluation without surgical intervention. Primary outcomes were discharge opioid-prescribing frequency and dosing in morphine-equivalent doses. Secondary outcomes were occurrence and timing of postdischarge follow-up. RESULTS: For 673 minimally injured traumapatients, opioid-prescribing frequency and morphine-equivalent doses prescribed decreased between 2015 and 2017 (49.3% to 31.5%, P = .006, mean 229 to 146 morphine-equivalent doses, P = .007). Decreases between 2017 and 2018 were not statistically significant. Acute prescribing limit compliance was 97% in 2018. After the acute prescribing limit was implemented, outpatient opioid prescribing did not increase and time to earliest follow-up did not decrease. CONCLUSION: Opioid-prescribing frequency and morphine-equivalent doses prescribed to minimally injured traumapatients decreased dramatically between 2015 and 2018. These changes occurred primarily before the implementation of an acute prescribing limit; however, incremental improvement and high compliance since implementation are demonstrated. Patients did not have significantly earlier follow-up encounters for pain or additional opioid prescriptions. Prospective research on pain control for minimally injured traumapatients is needed.
Authors: Brian T Young; Samuel J Zolin; Alexandra Ferre; Vanessa P Ho; Alexis R Harvey; Kevin T Beel; Esther S Tseng; Kristen Conrad-Schnetz; Jeffrey A Claridge Journal: Am J Surg Date: 2019-11-11 Impact factor: 2.565
Authors: Amy E Seitz; Karen A Janiszewski; Gery P Guy; Ryan T Tapscott; Emily B Einstein; Tamra E Meyer; Jessica Tierney; Judy Staffa; Christopher M Jones; Wilson M Compton Journal: Pharmacoepidemiol Drug Saf Date: 2022-03-17 Impact factor: 2.732
Authors: Ivelisse L Valdes; Marie-Christin Possinger; Juan M Hincapie-Castillo; Amie J Goodin; Marvin A Dewar; Jill M Sumfest; Scott M Vouri Journal: J Gen Intern Med Date: 2021-07-08 Impact factor: 6.473
Authors: Esther S Tseng; Samuel J Zolin; Brian T Young; Jeffrey A Claridge; Kristen J Conrad-Schnetz; Eric T Curfman; Nicole L Wise; Vetrica C Lemaitre; Vanessa P Ho Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697