A Prospective Evaluation of Patient-Reported Opioid Utilization After Nonoperative Treatment of Fractures and Dislocations
Bibliographic record
Abstract
BACKGROUND: Prescription of opioid analgesics is currently a common practice to relieve pain for musculoskeletal injuries in many regions of the world, especially in the United States and Canada. However, overprescription may underlie opioid misuse. Details on the utilization of prescribed opioids after nonoperative treatment of fractures and dislocations and whether consumption is related to injury location are unknown. METHODS: A total of 1,513 consecutive patients in China who underwent nonoperative treatment of a fracture and/or dislocation and who were prescribed opioids were studied over a 3-month period. Demographic information, alcohol consumption, smoking status, injury location, volume of prescription, and consumption patterns were recorded and were summarized. RESULTS: The mean number of opioid pills prescribed was 14.7, and the mean patient-reported number of pills consumed was 7.2. Overall, 152 patients (10.0%) reported taking no prescribed opioid analgesics, and 924 patients (61.1%) ceased their prescribed opioids prior to completing the regimen. Injury location, alcohol consumption, and type of fracture or dislocation were all significantly associated with the patient-reported number of opioid pills consumed (p < 0.05). Patients with fracture and/or dislocation of the wrist or forearm (9.4 pills for 3.8 days); ankle, tibia, or fibula (9.3 pills for 3.7 days); or elbow or humerus (9.1 pills for 3.7 days) used more opioid pills compared with patients with injuries at other locations (not exceeding 6.4 pills and 3 days). When compared with patients who had no, low, or moderate daily alcohol consumption, there was more opioid use in patients with high daily alcohol consumption (8.5 pills for 3.4 days) and those with very high daily alcohol consumption (11.3 pills for 4.7 days). Patients with a dislocation and/or displaced fracture reported consuming 8.2 pills for 3.3 days, which was more than the consumption in patients with a nondisplaced fracture (6.2 pills for 2.5 days) and patients with an avulsion fracture (6.2 pills for 2.5 days). CONCLUSIONS: Surgeons and patients should try to avoid opioids if possible after nonoperatively treated fractures and dislocations. If opioids are used, surgeons should prescribe the smallest dose for the shortest time after considering the injury location and type of fracture or dislocation. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".