The Complex Association of Race/Ethnicity With Pain Treatment Quality in an Urban Medical Center With 2 Pediatric Emergency Departments

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Abstract

Objective

This study aimed to explore racial differences in analgesia quality.

Methods

A retrospective cross-sectional study of 24,733 visits by individuals 21 years or younger with pain scores of 4 to 10 was performed using electronic medical records. We compared 2 process metrics, treatment with any analgesics within 60 minutes and treatment with opioids within 60 minutes, and one outcome metric, a reduction in pain score by 2 or more points within 90 minutes. Multivariable logistic regression adjusted for the effects of patient characteristics and health status. We also determined variations in analgesia quality among those with severe pain.

Results

When compared with white children, black children were more likely to receive any analgesia (adjusted odds ratio [aOR], 1.94; 95% confidence interval, 1.71–2.21), but both blacks (aOR, 0.66; 0.51–0.85) and Hispanics (aOR, 0.56; 0.39–0.80) were less likely to receive opioids. Blacks were more likely to reduce their pain score (aOR, 1.50; 1.28–1.76).

Results

Among children with severe pain, both blacks and Hispanics were more likely to receive any analgesia (black: aOR, 2.05 [1.71–2.46]; Hispanic: aOR, 1.29 [1.05–1.59]), and Hispanic children were less likely to receive opioids (aOR, 0.58; 0.37–0.91). Again, black children were more likely to reduce their pain score (aOR, 1.42; 1.13–1.79).

Conclusions

The relationship between race/ethnicity and analgesia is complex. Although minority children were less likely to receive opioids, black children had better treatment outcomes. Future studies should explore clinical response to analgesia in addition to process measures to better understand if differential treatment may be justified to achieve equitable care outcomes.

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