Abstract
Background
Rib fractures are painful injuries that are treated with aggressive analgesia, which
can include opioids. We sought to evaluate the patterns and predictors of opioid prescription
and sustained use for rib fracture patients to identify opportunities for opiate reduction.
Methods
We used TRICARE claims data (2006–2014) to identify adult (18–64 years) patients presenting
to the emergency department with rib fracture(s) and isolated chest trauma. We used
logistic regression and Cox proportional hazards model to identify factors associated
with opioid prescription and duration of use.
Results
We identified 29,943 patients meeting inclusion criteria, and 2,542 (9%) patients
were prescribed opioids. When prescribed, the median duration opioid use was 16 days
(interquartile range 6–31) for opioid naïve patients, compared with 36 days (interquartile
range 15–134) for those with prior opioid exposure. Increased number of ribs fractured
(6+ fractures) (odds ratio 2.96 [95% confidence interval 2.23–3.94], P < .001) and prior opioid exposure (odds ratio 32.95 [29.36–36.99], P < .001) were significant predictors of initial opioid prescription. Patients with
prior opioid exposure (hazard ratio 0.47 [0.43–0.52], P < .001) had lower likelihood of opioid discontinuation. Injury characteristics did
not significantly predict discontinuation.
Conclusion
Prior opioid exposure was the strongest predictor of sustained opioid use after rib
fractures, while the severity of injury did not predict the duration of use.
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Article info
Publication history
Published online: July 08, 2020
Accepted:
May 17,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
