A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

Abstract

Background Previous studies examining gender-based disparities in Emergency Department (ED) pain-care have been limited to a single pain-condition, a single study-site, and lack rigorous control for confounders. Objective A multicenter evaluation of the effect of gender on abdominal pain (AP) and fracture (FP) pain-care outcomes. Research Design Retrospective cohort-review of ED visits at 5 US hospitals in January, April, July and October 2009. Subjects 6,931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249). Measures The primary-predictor was gender. The primary outcome was time to analgesic-administration. Secondary outcomes included time to medication-order, and the likelihood the receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain-score, ED crowding and triage acuity. Results On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP Women: 112 (65–187) min, Men: 96 (52–167) min, p<0.001] and ordering Women: [84 (41–160) min, Men: 71 (32–137) min, p<0.001], whereas women with FP did not (Administration: p=0.360; Order: p=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR: 0.766, 95% CI: 0.670 – 0.875, p<0.001), whereas women with FP were not (p=0.357). Discussion In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease gender-disparities in pain-care should take type of pain into account.

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

“…Women waited longer than men for administration of analgesia (16‐min difference, 95% CI 3.5 to 33 min), despite reporting similar pain scores 193 . This is consistent with retrospective reviews demonstrating that being a woman with abdominal pain is associated with a lower likelihood of receiving pain medication and delayed time to administration of pain medication when compared to men 194,195 . A large retrospective study utilizing national data found that minorities had a decreased OR of receiving opioids in the ED when compared to non‐Hispanic White patients, 0.50 for Black patients, and 0.85 for Hispanics 196 .…”

“…193 This is consistent with retrospective reviews demonstrating that being a woman with abdominal pain is associated a lower likelihood of receiving pain medication and delayed time to administration of pain medication when compared to men. 194,195 A large retrospective study utilizing national data found that minorities had a decreased OR of receiving opioids in the ED when compared to non-Hispanic White patients, 0.50 for Black patients, and 0.85 for Hispanics. 196 While advocating for equity in analgesia, the writing group also recognized that medically appropriate differences in analgesia approaches may be warranted, based on factors such as pain mechanisms and adverse effects unique to individual patients (e.g., avoidance of NSAIDs in patients with advanced renal disease or gastrointestinal bleeding) or patient groups (e.g., use of Beers list to guide medication selection in older adults).…”

The roles of gender and profession on gender role expectations of pain in health care professionals

“… 2 These biases appear to affect treatment recommendations, as male patients are less likely to receive psychosocial assessment or treatment for pain 3 , 4 and women patients are less likely to receive more aggressive analgesic treatment. 5 , 6 …”

Race/Ethnicity and Sex and Opioid Administration in the Emergency Room

“…In a study from the University of Pennsylvania, women were 13%-25% less likely to receive opioid analgesia for abdominal pain and waited longer for any form of analgesia than male patients. 10 Siddiqui et al 9 showed that women with abdominal pain were less likely to receive analgesia within the first 180 minutes of a visit (OR = 0.91, 95% CI, 0.84-0.97) as compared to men, but there was no such sex discrepancy for patients with fracture pain, 9 and there is still further literature that does not show any difference for female as compared to male patients. 2,7 We do not know of any studies that have examined sex-based disparities in analgesic administration among pediatric populations.…”

“…Many studies have found significant disparities in treatment among races/ ethnicities, although to different degrees and in different specific contexts. [2][3][4][5][6][7][8] Likewise, there is some evidence that adult females receive more analgesics for acute pain than males, 3,8 but there is also evidence that they receive either fewer 9,10 or equal 2,7 amounts of analgesics.…”