Study Objectives: Sub-dissociative ketamine (SDK) is a safe and efficacious alternative and adjunctive agent to opioids in the treatment of acute pain in the emergency department (ED). While SDK via short intravenous (IV) infusion has shown decreased side effects compared to IV push, there is a wide range of acceptable analgesic dose. The purpose of this study is to compare the analgesic efficacy and safety of IV SDK at 0.15 mg/kg versus 0.3 mg/kg in ED patients with acute pain. Methods: This was a randomized, prospective, double-blinded, non-inferiority trial. A convenience sample of patients age 18-59 years with acute abdominal, flank, back, musculoskeletal pain, or headache with visual analog scale (VAS) pain score of 5 were included. Subjects were randomized to either IV SDK 0.15mg/kg (“low” dose) or 0.3 mg/kg (“high” dose) over 15 minutes. The primary endpoint was change in 11-point VAS pain score from baseline to 30 minutes after administration. Secondary endpoints included change in VAS at 15 and 60 minutes, and rescue analgesia. Safety endpoints included patient-reported adverse effects according to the Side Effects Rating Scale of Dissociative Anesthetics (SERSDA), and Richmond Agitation Sedation Scale (RASS) at 15, 30 and 60 minutes post-administration. Results: Of the 93 patients screened, 65 (70%) were included (low dose group: n¼33; high dose group: n¼32). Most exclusions were due to patient refusal (n¼ 25; 68%). The most common type of pain was abdominal (45%) or musculoskeletal (32%) pain. Pain onset was <24 hours of presentation for most (53%) patients. Baseline comorbidities were similar between groups, with the exception of diabetes (27% low dose group vs. 5.7% high dose group, p¼0.03), depression (2.7% low dose group vs. 20% high dose group, p¼0.03) and anxiety (0% low dose group vs. 11.4% high dose group, p¼0.03) (Table 1). Median ketamine dose was 13.6 mg and 25.3 mg, respectively. Median baseline pain scores were similar between groups (10 [IQR 8-10] vs. 9 [IQR 7 -10] , p ¼0.07). There was no difference in the primary endpoint of median change in VAS score from baseline to 30 minutes (- 4 [IQR [-2 to -6] low dose group vs. -3.5 high dose group [IQR -1 to -5], p¼.43). Additionally, there were no differences in median pain scores or adverse effects at any time point (Table 1). Conclusion: IV SDK 0.15 mg/kg was non-inferior to SDK 0.3 mg/kg for treatment of acute pain in the ED with similar adverse effects between groups. Clinicians should consider using 0.15 mg/kg for treatment of acute pain as it is efficacious, and there is no apparent benefit to higher doses. 257 Comparison of Analgesic Efficacy of Morphine Sulfate Immediate Release/ Acetaminophen vs. Oxycodone/ Acetaminophen (Percocet) for Acute Pain in Emergency Department Patients Motov S, Butt M, Masoudi A, Hossain R, Drapkin J, Likourezos A, Fassassi C, Brady J, Rothberger N, Flom P, Marshall J/Maimonides Medical Center, Brooklyn, NY; Peter Flom Consulting, Brooklyn, NY Study Objectives: Ibuprofen and acetaminophen (APAP) are commonly used analgesics in the pediatric ED for management of acute traumatic and nontraumatic pain. However, the analgesic benefits of combination ibuprofen and acetaminophen in this specific setting do not exist, only in pediatric patients with postoperative pain. Our aim is to evaluate analgesic efficacy, safety and feasibility of combination therapy to potentially broaden its clinical application in the pediatric ED. We hypothesize that combination of oral ibuprofen and APAP is superior to either analgesic alone and is an excellent analgesic modality for controlling acute traumatic/nontraumatic pain in the pediatric ED. Methods: We conducted a prospective, randomized; double-blind trial evaluating ED patients aged 3-17 years with acute pain. Enrolled patients were randomized to three groups: Group 1: oral ibuprofen at 10mg/kg dose and placebo of equal volume; Group 2: oral APAP at 15 mg/kg dose and placebo of equal volume; and, Group 3: oral ibuprofen at 10 mg/kg dose and APAP at 15mg/kg dose. Analgesics were administered orally via pre-filled syringes of identical volume, color, and flavor. Pain scores were recorded on a standard Numeric Rating Scale (NRS) and Wong-Baker (FACES) Scale at baseline and 60 minutes. Primary outcome is the comparative reduction of pain via NRS/ FACES pain scale at 60 minutes from administration of medication. Secondary outcomes include incidence and type of adverse events, need for rescue analgesia, and patients’ and parents’ satisfaction with achieved level of analgesia. Data were analyzed by intention-to-treat using frequency distributions, chi-square test, and ANOVA. Power analysis indicated a need for total enrollment of 90 patients. Results: We enrolled 90 subjects (30 per group). The demographic characteristics were similar for all three groups (P>.05). The mean NRS pain scores at baseline were 5.1, 5.8, and 5.8 (p¼0.316) and improved to 2.3, 3.0, 2.7 (p¼0.549) at 60 minutes respectively. The difference in mean pain scores at 60 minutes between group 1 and group 2 was -0.63 (95% CI: -1.81 to 0.54); between group 1 and group 3 was -0.33 (95% CI: -1.47 to 0.81); and between group 2 and group 3 was 0.29 (-0.84 to 1.43). The reduction in mean numeric rating scale pain scores were statistically significant from baseline to 60 minutes within each group: 2.8 (95% CI: 2.0 to 3.5) for group 1; 2.7 (95% CI: 1.9 to 3.5) for group 2; and 3.1 (95% CI: 2.4 to 3.8) for group 3, respectively. No clinically concerning changes in vital signs were observed. There were no serious adverse events in each group. Conclusion: The combination of oral ibuprofen and APAP therapy is not superior to either drug alone for controlling acute traumatic/nontraumatic pain in the pediatric ED. 258 Withdrawn 259 Racial Demographics and Resource Utilization Among Teenagers with Firearm-Related Injuries Presenting to the Emergency Department, 2010-2015 Quan T, Sarani B, Fair M, Pourmand A/George Washington University, School of Medicine and Health Sciences, Washington, DC Study Objectives: Health disparities exist in chronic diseases, injuries and illnesses. In firearm-related injuries, Black teenagers constitute a significant number of the gunshot wound (GSW) victims in the emergency department (ED) compared to White teenagers. In this study, we utilize a national database to describe the Research Forum Abstracts Volume 74, no. 4s : October 2019 Annals of Emergency Medicine S101