largest rates of increase. Importantly, opioid medications have dem-onstrated a generally rising rate of prescription for all body regions,except the elbow and the head (5-11% per year, P�.05). The largestincreases in opioid prescription rate were for the hip (10% per year)and the neck (11% per year).Conclusions: We have described a rising incidence of regionalbody pain in the ED. The corresponding increasing trend ofopioid medication prescriptions suggests that opioid medica-tions may be relied on as a temporizing measure in the ED. Giventhe progressively important role of the ED in healthcare accessand delivery, judicious pain management strategies are war-ranted.

Poster 207Gender and Racial Disparities in OpioidMedication Prescription for Regional Body Pain inthe Emergency Department.Lyly Cao Minh, MD (Stanford University, Palo Alto, CA,United States); Salar Deldar, MD; Grace Y. Huang, MD;Ming-Chih J. Kao, PhD, MD; Matthew Smuck, MD; Jef-frey K. Teraoka, MD.

Disclosures: L. Cao Minh, No Disclosures.Objective: To describe differences in the rate of opiate medica-tion (OM) prescription by race and gender for regional body pain inEmergency Departments (EDs) in the United States (US).Design: ED data from National Hospital and Ambulatory MedicalCenter Survey (NHAMCS) from 1996-2008 were analyzed usingSAS version 9.2 (Cary, NC, USA) and R (http://r-project.org). Forvariance estimation, masked “ultimate cluster” weights were usedfor 2002-06. Domain analysis was used in subset analyses.Weighted logistic regression was used to adjust for demographicfactors.Setting: National multi-stage probability survey of U.S. EDs.Participants: Patients who presented at a set of randomly selectedhealthcare facilities on the days of data collection.Interventions: In silico.Main Outcome Measures: Rates of OM prescription for var-ious regional body pains: axial (headache, neck, back, low back),upper extremity (shoulder, arm, elbow, wrist, hand), lower extrem-ity (hip, leg, knee, ankle, foot) by race (African-American, Hispanic,white) and gender (male, female).Results: Controlling for age and gender, African-Americans wereless likely to receive OM for head (OR�0.43, P�.001), back(OR�0.45, P�.001), hip (OR�0.46, P�.01), and arm pain(OR�0.47, P�.003) compared to white male controls. There ap-pears to be a trend toward normalization of this disparity. Control-ling for age and gender, Hispanics were less likely to receive OM forhead (OR�0.41, P�.001) and back pain (OR�0.55, P�.001)compared to white male controls. Controlling for age and race,females were less likely to receive OM for headache (OR�0.64,P�.002) but more likely to receive OM for back pain (OR�1.48,P�.001), a trend that was normalizing at 4% per year.Conclusions: We describe robust 13-year trends on race andgender disparities in U.S. EDs showing statistically significantlydifferent rates of OM prescription. We reveal African-Americansand Hispanics were not only less likely to receive OM for low backpain, but also for headache. These disparities have shown somerecent changes, but not statistically significantly so. Females werealso less likely to receive OM for headache. Interestingly, females

were historically more likely to receive OM for back pain before theyear 2000; however, this trend demonstrated normalization inrecent years, likely reflecting changes in practice patterns.

Poster 208Upper Extremity Deep Vein Thrombosis FollowingAir Travel: A Case Report.Mahmud M. Ibrahim, MD (Mount Sinai School of Med-icine, New York, NY, United States); Joseph Herrera, DO.

Disclosures: M. M. Ibrahim, No Disclosures.Case Description: Patient: A 70-year-old man with a history ofgout presented for evaluation of a swollen hand after an overseasflight.Case Description: The patient presented for evaluation of aswollen right hand. About 2 weeks prior, he had flown from NYC toItaly. While in Europe, he noticed some minimal swelling of hisright hand. The day after he flew back, the swelling significantlyworsened. Physical examination revealed a severely swollen non-discolored right hand. The swelling extended to approximately themiddle of his forearm. There was venous distension along theforearm. There were no abnormal rashes, ulcerations, or evidence ofinsect bites along the extremity. There was no joint tenderness andthe hand was warm to touch. Radial and ulnar pulses were detect-able with good capillary refill. The remainder of the examinationwas unremarkable.Setting: Outpatient musculoskeletal office.Results or Clinical Course: The patient was sent for an upperextremity Doppler, which revealed a thrombus in a tributary vein ofthe right brachial vein.Discussion: The incidence of symptomatic DVT secondary toprolonged air travel has been estimated to occur at only 0.05% of allDVTs. DVT in the upper extremity is reported to account for only1-2% of all venous thrombosis. Upper extremity DVTs usuallydevelop in patients with cancer or those who underwent insertion ofa central venous line. Prolonged air travel has been shown to be arisk factor for developing lower extremity DVT; however, there areno published reports of a correlation between prolonged air traveland upper extremity DVT. Passengers are often immobilized incramped positions for hours and subjected to low air pressure withrelative hypoxia and low humidity, which may cause dehydrationand a subsequent hypercoagulable state.Conclusions: It is important to consider this rare diagnosis inindividuals with these symptoms, especially in the setting of othermedical problems, such as gout, which may have a similar presen-tation.

Poster 209Failure of Platelet-Rich Plasma in the Treatment ofHip Osteoarthritis: A Case Report.Mahmud M. Ibrahim, MD (Mount Sinai School of Med-icine, New York, NY, United States); Joseph Herrera, DO.

Disclosures: M. M. Ibrahim, No Disclosures.Case Description: A 46-year-old man with a history of left hipOA had previously received several intra-articular injections withsteroids and hyaluronic acid derivatives with minimal lasting relief.He then underwent a series of 3 platelet-rich plasma (PRP) injec-tions over a 4.5-month period.Setting: Musculoskeletal office.Results or Clinical Course: Initially, WOMAC scores im-

S260 PRESENTATIONS