Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

Goyal, Monika K.; Kuppermann, Nathan; Cleary, Sean D.; Teach, Stephen J.; Chamberlain, James M.

doi:10.1001/jamapediatrics.2015.1915

Cited by 395 publications

(305 citation statements)

References 37 publications

(31 reference statements)

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“…Analgesia provision appeared suboptimal with regards to underdosing, delayed timing, and inappropriate use of mild oral analgesics for a condition that is known to cause moderate to severe pain in 91% of patients. 11 Only two-thirds of children received any analgesia while in the PED. Despite being the recommended analgesic for severe pain, less than half of all children in our national study received an opioid analgesic agent.…”

Section: Discussionmentioning

confidence: 99%

“…10 When compared practice patterns in prior literature, our study demonstrated similar rates of both overall analgesia and opioid provision. 11,13 In a recent American study of a large national database, 56.8% of pediatric patients with acute appendicitis received analgesia, with 41.3% receiving an opioid analgesic. 11 Similarly, a smaller study demonstrated that 60% of patients with acute appendicitis received analgesia while in a PED, with 45% receiving morphine.…”

Section: Discussionmentioning

confidence: 99%

“…11,13 In a recent American study of a large national database, 56.8% of pediatric patients with acute appendicitis received analgesia, with 41.3% receiving an opioid analgesic. 11 Similarly, a smaller study demonstrated that 60% of patients with acute appendicitis received analgesia while in a PED, with 45% receiving morphine. 13 Still, practice continues to be suboptimal, given that less than half of all children received an IV opioid.…”

Section: Discussionmentioning

confidence: 99%

“…10 Appendicitis is known to be a painful condition; recent literature reported that 50.1% of children with appendicitis had pain scores consistent with severe pain, with an additional 40.9% in moderate pain. 11 Therefore, given the likelihood of moderate to severe pain in appendicitis, optimal management would be to provide analgesia early in an ED visit, with the majority of patients receiving opioid analgesics.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] The reasons for this are multifactorial and include age-dependent clinical presentation, difficulty in assessing pain in children, lack of comfort in using opioids in children, time constraints in busy acute care settings, and unwarranted concerns of obscuring the signs and symptoms of a surgical abdomen. 10 A review of current practice patterns regarding pain management may encourage and form a basis for focused knowledge translation strategies to support optimal analgesic use for suspected appendicitis in children.…”

Section: Introductionmentioning

confidence: 99%

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Pain management of acute appendicitis in Canadian pediatric emergency departments

Robb

Ali

Poonai

et al. 2016

CJEM

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Objectives: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). Methods: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision. Results: A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pain management of acute appendicitis in Canadian pediatric emergency departments

Robb

Ali

Poonai

et al. 2016

CJEM

View full text Add to dashboard Cite

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How Should Educators and Publishers Eliminate Racial Essentialism?

Tsai¹

2022

AMA Journal of Ethics

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Racial essentialism-the belief that socially constructed racial categories reflect "inherent" biological differences-exacerbates learners' racial prejudice and diminishes their empathy. Essentialism hinders health professions education programs' capacity to generate a health care work force that motivates ethics and equity in health care and research. This article suggests how health professions educators and institutions should reform pedagogy on race, when clinically relevant, to emphasize racism as the root cause of health inequity. Publishers of research also have key roles in reform and should enforce appropriate and just references to race in journals and health professions education content.

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Association of Patient Race and Ethnicity With Differences in Opioid Prescribing by Primary Care Physicians for Older Adults With New Low Back Pain

2021

JAMA Health Forum

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IMPORTANCE Substantial patient racial and ethnic differences in opioid prescribing have been documented, but how much of these differences were attributable to physicians prescribing opioids differently to patients of racial and ethnic minority groups is unknown, particularly during the first wave of the opioid epidemic when the dangers of opioid prescribing and use were not as well known. OBJECTIVETo examine associations of patient race and ethnicity with differences in opioid prescribing by the same primary care physician (PCP) for new low back pain episodes among older adults from 2007 to 2014. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used Medicare data of PCP office visits by Medicare beneficiaries who were 66 years or older with new low back pain. MAIN OUTCOMES AND MEASURES Prescribing of any opioid in the first year of a new low back pain episode (days 1-365) and subsequent long-term use of an opioid (prescribed for Ն180 days in days 366-730). RESULTS Among the study population of 274 771 patients (mean [SD] age, 77.1 [7.2] years; 192 105 [69.9%] women) with new low back pain, 15 285 (6%) were Asian or Pacific Islander, 16 079 (6%)were Black, 21 289 (8%) were Hispanic, and 222 118 (81%) were White, cared for by 63 494 physicians. In adjusted analysis, on average, 11.5% of the White patients (95% CI, 11.4 to 11.6) received an opioid prescription in the first year of new low back pain. The same prescribing physician was 1.5 percentage points (PP; 95% CI, −2.2 PP to −0.8 PP) less likely to prescribe an opioid if the patient was Black, 2.7 PP (95% CI, −3.5 PP to −1.8 PP) less likely if the patient was Asian or Pacific Islander, and 1.0 PP (95% CI, −1.7 PP to −0.3 PP) less likely if the patient was Hispanic. The same physician was more likely to prescribe a prescription nonsteroidal anti-inflammatory drug to a patient of a racial or ethnic minority group. White patients with new low back pain were more likely to develop subsequent long-term opioid use than patients of racial and ethnic minority groups (eg, 1.8% for White patients vs 0.5% for Hispanic patients). CONCLUSIONS AND RELEVANCEThis cross-sectional study found that from 2007 to 2014, primary care physicians prescribed opioids for new low back pain more often to White patients than to patients of racial and ethnic minority groups. These results suggest that there may have been unequal treatment of pain by physicians when less was known about the morbidity associated with opioid use.

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Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

Cited by 395 publications

References 37 publications

Pain management of acute appendicitis in Canadian pediatric emergency departments

Pain management of acute appendicitis in Canadian pediatric emergency departments

How Should Educators and Publishers Eliminate Racial Essentialism?

Association of Patient Race and Ethnicity With Differences in Opioid Prescribing by Primary Care Physicians for Older Adults With New Low Back Pain

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