Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference

Abstract

Background: There are disparities in pain management for children presenting to the emergency department (ED) according to their racial and ethnic backgrounds. It is not known if there are differences in the treatment of pain associated with pediatric migraines by race, ethnicity, and language for care (REaL). Methods:We analyzed treatment patterns and outcomes in our ED for acute migraine in pediatric patients by REaL. Retrospective data on treatments, length of stay (LOS), and charges were collected from the electronic medical record for pediatric patients on the ED migraine pathway from October 2016 to February 2020. Patient race/ ethnicity and language for care were self-reported at registration. We analyzed two treatment groups: receipt of oral (PO) or intranasal (IN) medications only or intravenous (IV) ± IN/PO medications. A total of 833 patients (median age 14.8 years, interquartile range [IQR] 12.3-16.5 years; 67% female, 51% non-Hispanic White (nHW), 23% Hispanic, 8.3% Black or African American, 4.3% Asian) were included. A total of 287 received PO/IN medications only and 546 received IV medications.Results: Initial pain scores in the two groups were similar. Patients who were Asian, Black or African American, and Hispanic or had a language for care other than English (LOE) had significantly lower odds of receiving IV treatment, while patients who were nHW and preferred English had higher odds of receiving IV treatment. The IV treatment group had longer LOS and ED charges. Pediatric ED patients with migraine who were Black, Asian, and Hispanic or had a LOE had a decreased likelihood of receiving IV therapies while patients who were nHW were more likely to receive IV treatments, despite similar initial pain scores.Conclusions: These data align with previous studies on pain management disparities and highlight another area where we must improve equity for patients in the ED.

Eliminating pain disparities for children in the emergency department

“…Despite American Academy of Pediatrics and the American College of Emergency Physicians policies citing pediatric pain management as a priority and central component of patient‐ and family‐centered care, inadequate pain management remains prevalent in the ED 4 . To date, racial and ethnic disparities in pediatric pain management in the ED have been documented surrounding the treatment of bone fractures, appendicitis, migraines, and general pain management 2,3,5 . Collectively, data from this work indicate that, after controlling for clinical presentation and severity, children who are members of minoritized racial and ethnic groups are less likely to receive optimal pain care in the ED.…”

“…4 To date, racial and ethnic disparities in pediatric pain management in the ED have been documented surrounding the treatment of bone fractures, appendicitis, migraines, and general pain management. 2,3,5 Collectively, data from this work indicate that, after controlling for clinical presentation and severity, children who are members of minoritized racial and ethnic groups are less likely to receive optimal pain care in the ED. Millions of children require pain-related treatment in the ED each year and inadequate pain care is distressing and may contribute to negative short-and long-term clinical outcomes (e.g., heightened physiological pain responses and pain sensitivity, poorer recovery, increased pain and anxiety surrounding future Supervising Editor: Dr. Robert Cloutier.…”

The Association of Emergency Severity Index Score and Patient and Family Experience in a Pediatric Emergency Department

“… 18 , 19 This interaction deserves further exploration, especially given the frequently reported disparate care for Hispanic patients in the PED. 20 – 23 …”

AI-Driven Emergency Patient Flow Optimization is Both an Unmissable Opportunity and a Risk of Systematizing Health Disparities

“…It was also observed that black patients were less likely to undergo tests in the ED (Zhang et al 2020a). Furthermore, disparities in racial/ethnic and language-based pain management in pediatric EDs were identified (Hartford et al 2022).…”