Race, Ethnicity, and Management of Pain from Long‐bone Fractures: A Prospective Study of Two Academic Urban Emergency Departments

Abstract

Objectives: The objective was to test the hypothesis that African American and Hispanic patients are less likely to receive analgesics than white patients in two academic urban emergency departments (EDs).Methods: This was a prospective observational study of a convenience sample of patients with longbone fractures from April 2002 to November 2006 in two academic urban EDs. Eligibility criteria were age 18-55 years, isolated long-bone fracture, and race and ethnicity (Hispanic, African American, and white). The primary outcome was receipt of analgesics; secondary outcomes included receipt of opioids, dose, route, time to first analgesic, and change in pain. Logistic regression was used to adjust the risk of receiving analgesics for patients' initial rating of pain and demographic characteristics.Results: Of 1,239 patients with suspected long-bone fractures, 345 patients were eligible: 177 (51%) were Hispanic, 98 (28%) were African American, and 70 (20%) were white. Administration of analgesics was not associated with race or ethnicity. Sixteen percent (95% confidence interval [CI] = 11% to 22%) of Hispanic, 15% (95% CI = 10% to 24%) of African American, and 14% (95% CI = 8% to 24%) of white patients did not receive any analgesics. Seventy-four percent of Hispanic (95% CI = 67% to 80%), 66% of African American (95% CI = 57% to 75%), and 69% (95% CI = 57% to 78%) of white patients received opioid analgesics. After adjustment for covariates, there was no evidence of an association between receipt of analgesics or opioid analgesics and the race or ethnicity of the patients. There were no significant differences in time to treatment, dose, route, or change in pain.Conclusions: Receipt of analgesics for pain from long-bone fractures was not associated with patient race or ethnicity in two academic urban EDs.ACADEMIC EMERGENCY MEDICINE 2008; 15:589-597 ª

Emergency Department Pain Management and Its Impact On Patients’ Short Term Outcome

“…Occasionally, a poor choice of analgesics, including a non-preferred route of administration, appears to alter the efficacy of acute pain treatment in the ED [9]. Gender, age, and ethnic biases have also been found to contribute to the lack of analgesic administration in the emergency setting [11], however undertreatment of pain was not confirmed to be associated with patient race or ethnicity [5]. Medical education has often been suggested as a mandatory way to improve the treatment of acute pain in ED [14].…”

“…Many retrospective and prospective studies demonstrated that pain as patient's symptom is underestimated [1][2][3][4][5][6]. In a recent study timely and adequate treatment of pain has been demonstrated to be suboptimal, as 30% of patients reporting the same or more pain at time of discharge, and just over half rated their pain at discharge as moderate or severe [5]. Bonica et al, in a review of over 25,000 pages in 50 major textbooks covering *Address correspondence to this author at the Emergency Medicine Department, Sant'Andrea Hospital, "Sapienza" Rome University -Emergency Medicine Postgraduate, School of Medicine and Psychology, Via di Grottarossa 1035-1039, 00189 Rome Italy; Tel: 0633775592; Fax: 0633775890; E-mail: benedetta.db@gmail.com medicine, surgery, paediatrics, and emergency medicine, demonstrated that only 54 pages were addressed to the treatment of pain [7].…”

The impact of race and ethnicity on care in the pediatric emergency department

“…Under the aegis of the Hippocratic Oath, the nature of healthcare providers is to bestow ethical and equitable care to children in need without regard to factors such as race or ethnicity. The attainment of this ideal is possible, as demonstrated by research showing the absence of racial and ethnic disparities observed in the treatment and pain management of pediatric fractures [48][49][50]. With increased awareness and promotion of additional humanistic-driven research, further systemic changes are possible.…”

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

“…In addition, there were no signifi cant differences in time to administrate treatment, in dosages of analgesics, in the route of the analgesics were given, or in the changes in pain. 26 …”