• Monika K Goyal, Tiffani J Johnson, James M Chamberlain, Lawrence Cook, Michael Webb, Amy L Drendel, Evaline Alessandrini, Lalit Bajaj, Scott Lorch, Robert W Grundmeier, Elizabeth R Alpern, and PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN).
• Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children's National Health System and The George Washington University, Washington, District of Columbia; mgoyal@childrensnational.org.
• Pediatrics. 2020 May 1; 145 (5).

ObjectivesTo test the hypotheses that minority children with long-bone fractures are less likely to (1) receive analgesics, (2) receive opioid analgesics, and (3) achieve pain reduction.MethodsWe performed a 3-year retrospective cross-sectional study of children <18 years old with long-bone fractures using the Pediatric Emergency Care Applied Research Network Registry (7 emergency departments). We performed bivariable and multivariable logistic regression to measure the association between patient race and ethnicity and (1) any analgesic, (2) opioid analgesic, (3) ≥2-point pain score reduction, and (4) optimal pain reduction (ie, to mild or no pain).ResultsIn 21 069 visits with moderate-to-severe pain, 86.1% received an analgesic and 45.4% received opioids. Of 8533 patients with reassessment of pain, 89.2% experienced ≥2-point reduction in pain score and 62.2% experienced optimal pain reduction. In multivariable analyses, minority children, compared with non-Hispanic (NH) white children, were more likely to receive any analgesics (NH African American: adjusted odds ratio [aOR] 1.72 [95% confidence interval 1.51-1.95]; Hispanic: 1.32 [1.16-1.51]) and achieve ≥2-point reduction in pain (NH African American: 1.42 [1.14-1.76]; Hispanic: 1.38 [1.04-1.83]) but were less likely to receive opioids (NH African American: aOR 0.86 [0.77-0.95]; Hispanic: aOR 0.86 [0.76-0.96]) or achieve optimal pain reduction (NH African American: aOR 0.78 [0.67-0.90]; Hispanic: aOR 0.80 [0.67-0.95]).ConclusionsThere are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve ≥2-point reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.Copyright © 2020 by the American Academy of Pediatrics.

25 keywords...

hide…