Race and Sex Are Associated With Variations in Pain Management in Patients Presenting to the Emergency Department With Undifferentiated Abdominal Pain

Drogell, Kristin; Kincade, Brianna; Melaku, M.; Mangira, Caroline; Burns, Andrew; Krizo, Jessica

doi:10.1016/j.jemermed.2022.09.001

Cited by 2 publications

(2 citation statements)

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“…The large sample size and diversity of ICUs signals that depth of sedation may indeed differ by race, which differs somewhat from a previous study in critically ill pediatric patients where there was a lack of distinct patterns in sedation management that consistently favored one race or ethnicity over another ( 17 ). Our current processes for systematic assessment of sedation depth and intensity may not be equitable, as landmark trials in sedation practices enroll limited numbers of non-White patients ( 1 , 18 , 19 ), pain management practices continue to differ by race in acute care settings ( 14 ), and we have not directly measured how implicit bias mediates sedation practices ( 17 ). Although the distribution is bimodal for the primary outcome, a binary outcome of spending the entirety of the first 48 hours in deep sedation is also statistically significant, favoring less deep sedation in White patients.…”

Section: Discussionmentioning

confidence: 99%

“…Sedation practices in ICUs are heterogeneous and variability in patient responses to sedatives and analgesics may be implicated in worse outcomes. Racial disparities are present in the treatment of pain ( 13 , 14 ), but have never been evaluated in sedation practices. Therefore, our objective was to evaluate associations of race with the depth of sedation among mechanically ventilated adults.…”

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confidence: 99%

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Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Ramadurai,

Kohn,

Hart

et al. 2023

Critical Care Explorations

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OBJECTIVES: To evaluate the association of race with proportion of time in deep sedation among mechanically ventilated adults. DESIGN: Retrospective cohort study from October 2017 to December 2019. SETTING: Five hospitals within a single health system. PATIENTS: Adult patients who identified race as Black or White who were mechanically ventilated for greater than or equal to 24 hours in one of 12 medical, surgical, cardiovascular, cardiothoracic, or mixed ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure was White compared with Black race. The primary outcome was the proportion of time in deep sedation during the first 48 hours of mechanical ventilation, defined as Richmond Agitation-Sedation Scale values of –3 to –5. For the primary analysis, we performed mixed-effects linear regression models including ICU as a random effect, and adjusting for age, sex, English as preferred language, body mass index, Elixhauser comorbidity index, Laboratory-based Acute Physiology Score, Version 2, ICU admission source, admission for a major surgical procedure, and the presence of septic shock. Of the 3337 included patients, 1242 (37%) identified as Black, 1367 (41%) were female, and 1002 (30%) were admitted to a medical ICU. Black patients spent 48% of the first 48 hours of mechanical ventilation in deep sedation, compared with 43% among White patients in unadjusted analysis. After risk adjustment, Black race was significantly associated with more time in early deep sedation (mean difference, 5%; 95% CI, 2–7%; p < 0.01). CONCLUSIONS: There are disparities in sedation during the first 48 hours of mechanical ventilation between Black and White patients across a diverse set of ICUs. Future work is needed to determine the clinical significance of these findings, given the known poorer outcomes for patients who experience early deep sedation.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Ramadurai,

Kohn,

Hart

et al. 2023

Critical Care Explorations

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Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH)

Barr

Popkin

Roodzant

et al. 2023

Translational Behavioral Medicine

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Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women’s health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.

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Race and Sex Are Associated With Variations in Pain Management in Patients Presenting to the Emergency Department With Undifferentiated Abdominal Pain

Cited by 2 publications

References 15 publications

Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH)

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