Opioid Prescribing Patterns and Characteristics of Hand Injury Presentations to the Emergency Department of a Surgical Referral Centre in Western Sydney.

OBJECTIVE

High rates of opioid prescribing in the acute care setting are contributing to misuse and dependence. With hand injuries comprising a significant proportion of presentations to Australian emergency departments, this study aims to better understand analgesia prescribing practices for these injuries and the characteristics of such presentations.

METHODS

This retrospective single-centre cohort study reviews data from 282 adult hand injury presentations to a major hand surgery referral centre in Western Sydney. Descriptive statistics have been used to detail the characteristics of these presentations along with analgesia prescribing patterns. With a focus on opioid prescribing, univariate and multivariate analyses have been performed to determine any statistically significant relationships.

RESULTS

The mean age at presentation for the cohort was 39.7 years old, with the most common demographic being adult males (74.8%). Of the presenting injuries, lacerations were most common, present in 61.3% of cases. Opioids were administered in 16.3% of cases, with oral oxycodone 5 mg being the most common first choice of opioid. Multivariate analyses identified four independently significant hand injury characteristics that resulted in greater opioid administration. These characteristics were tendon injuries (OR: 2.513), muscle bed injuries (OR: 6.784), involvement of the radial nerve distribution (OR: 2.295) and involvement of multiple nerve distributions (OR: 2.972).

CONCLUSIONS

The opioid administration rate found in this study is elevated when compared to the available literature. These results may prompt Australian emergency physicians to rationalise their use of opioids for hand injuries with consideration of alternatives such as regional analgesia.