Introduction: Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration.

Methods: We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July 1, 2011 – June 30, 2012 and were given a prescription for a controlled opioid. Our primary purpose was to characterize each prescription as to the type of controlled substance, the quantity dispensed, and the duration of the prescription. We also looked at outliers, those patients who received prescriptions for longer than five days.

Results: A total of 9,502 prescriptions were written for opioids out of a total 63,143 prescriptions for 69,500 adult patients. Twenty-six (0.27%) of the prescriptions for controlled opioids were written for greater than five days. Most prescriptions were for five days or less (99.7%, 95% CI [99.6 to 99.8%]).

Conclusion: The vast majority of opioid prescriptions in our ED prior to the I-STOP legislature were limited to a five-day or less supply. These new regulations were meant to reduce the ED’s contribution to the rise of opioid related morbidity. This study suggests that the emergency physicians’ usual prescribing practices were negligibly limited by the new restrictive regulations. The ED may not be primarily contributing to the increase in opioid-related overdoses and death. The effect of the I-STOP regulation on future prescribing patterns in the ED remains to be determined. [West J Emerg Med. 2015;16(1):–0.]

Introduction: To provide an epidemiological description of radial head subluxation, also known asnursemaid’s elbow, from a database of emergency department visits.Methods: We conducted a retrospective medical record review of patients 6 years of age and younger,who presented to the ED between January 1, 2005, and December 31, 2012, and were diagnosed withnursemaid’s elbow. Inclusion criteria consisted of chart information, including date, unique accountnumber, medical record number, weight, age, sex, and arm affected. Exclusion criteria included anycharts with missing or incomplete data.Results: There were 1,228 charts that met inclusion criteria. The majority of patients were female(60%). The mean age was 28.6 months (612.6). The left arm was affected 60% of the time.Most of the included patients were over the 75th percentile for weight and more than one quarter wereover the 95th percentile in each gender.Conclusion: The average age of children presenting with nursemaid’s elbow was 28.6 months.Females were affected more than males, and the left arm was predominately affected. Most patientswere above the 75th percentile for weight and more than one quarter were over the 95th percentile forweight. [West J Emerg Med. 2014;15(4):554–557.]