{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:23:38Z","timestamp":1782530618463,"version":"3.54.5"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T00:00:00Z","timestamp":1497916800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJEM"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1481803517000379_abs1\" sec-type=\"general\"><jats:title>Background<\/jats:title><jats:p>Vertigo is common in the emergency department (ED). Most aetiologies are peripheral and do not require hospitalization, but many patients still fear falling. Some patients may be taking opioid analgesic medications (for other reasons); the risk of falls leading to fractures among patients with vertigo could be potentiated by the simultaneous use of opioids.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517000379_abs2\" sec-type=\"objectives\"><jats:title>Objectives<\/jats:title><jats:p>To examine the risk of fractures in discharged ED patients with peripheral vertigo who were being prescribed opioids during the same time period.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517000379_abs3\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Linked administrative databases from Ontario were used to compare discharged ED patients aged \u226565 with peripheral vertigo to patients with urinary tract infection (UTI) from 2006 to 2011. We used Cox regression analysis with an interaction term to estimate the modifying effect of an opioid prescription on the hazard of fracture within 90 days.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517000379_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>There were 13,012 patients with a peripheral vertigo syndrome and 76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI cohort had access to a filled opioid prescription. Compared to vertigo patients who did not fill an opioid prescription, the adjusted hazard of fracture among vertigo patients who did fill a prescription was 3.59 (95% CI 1.97\u20136.13). Among UTI patients who filled an opioid prescription the hazard ratio was 1.68 (95% CI 1.43\u20131.97) compared to UTI patients who did not.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517000379_abs5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Patients discharged from the ED with peripheral vertigo who were also being prescribed opioids had a higher hazard of subsequent fracture compared to those who were not, and the effect was much greater than among UTI patients. These results suggest that in the acutely vertiginous older patient, opioid analgesic medications should be modified, where possible.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cem.2017.37","type":"journal-article","created":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T09:27:30Z","timestamp":1497950850000},"page":"28-35","source":"Crossref","is-referenced-by-count":4,"title":["The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo"],"prefix":"10.1007","volume":"20","author":[{"given":"Keerat","family":"Grewal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moira K.","family":"Kapral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare L.","family":"Atzema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,6,20]]},"reference":[{"key":"S1481803517000379_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0b013e31817533a3"},{"key":"S1481803517000379_ref14","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2002.123839"},{"key":"S1481803517000379_ref20","volume-title":"The Johns Hopkins ACG\u00ae System: Decades of Impact on Population Health Research and Practice"},{"key":"S1481803517000379_ref10","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12148"},{"key":"S1481803517000379_ref13","volume-title":"Living and Dying in Ontario: An Opportunity for Improved Health Information","author":"Iron","year":"2008"},{"key":"S1481803517000379_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-10-75"},{"key":"S1481803517000379_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24521"},{"key":"S1481803517000379_ref9","first-page":"826","article-title":"Trends in high-dose opioid prescribing in Canada","volume":"60","author":"Gomes","year":"2014","journal-title":"Can Fam Physician"},{"key":"S1481803517000379_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.66"},{"key":"S1481803517000379_ref16","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.3.512"},{"key":"S1481803517000379_ref21","volume-title":"Implementation Guidelines for the Canadian Emergency Department Triage and Acuity Scale (CTAS)","author":"Beveridge","year":"2015"},{"key":"S1481803517000379_ref18","first-page":"e18","article-title":"Accuracy of administrative databases in identifying patients with hypertension","volume":"1","author":"Tu","year":"2007","journal-title":"Open Med"},{"key":"S1481803517000379_ref8","unstructured":"International Opioids Control Board. Opioid Consumption Motion Chart. Madison: Board of Regents of the University of Wisconsin System; 2012. Available at: https:\/\/ppsg.medicine.wisc.edu\/chart (accessed May 18, 2017)."},{"key":"S1481803517000379_ref11","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.007087"},{"key":"S1481803517000379_ref3","doi-asserted-by":"publisher","DOI":"10.1097\/00063110-199512000-00006"},{"key":"S1481803517000379_ref2","volume-title":"Clinical Methods: The History, Physical, and Laboratory Examinations","author":"Walker","year":"1990"},{"key":"S1481803517000379_ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00189.x"},{"key":"S1481803517000379_ref5","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0b013e31823d07b6"},{"key":"S1481803517000379_ref6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2010.03585.x"},{"key":"S1481803517000379_ref12","unstructured":"Ontario Ministry of Health and Long-Term Care. Ontario Health Insurance Plan (OHIP). 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