• Ammar Siddiqui, Laura Belland, Laura Rivera-Reyes, Daniel Handel, Kabir Yadav, Kennon Heard, Amanda Eisenberg, and Ula Hwang.
• *Emergency Department, Icahn School of Medicine at Mount Sinai, New York, NY †Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC ‡Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA §Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO ∥Mount Sinai Beth Israel, New York, NY.
• Med Care. 2015 Nov 1; 53 (11): 948-53.

BackgroundPrevious studies examining sex-based disparities in emergency department (ED) pain care have been limited to a single pain condition, a single study site, and lack rigorous control for confounders.ObjectiveA multicenter evaluation of the effect of sex on abdominal pain (AP) and fracture pain (FP) care outcomes.Research DesignA retrospective cohort review of ED visits at 5 US hospitals in January, April, July, and October 2009.SubjectsA total of 6931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249) were included.MeasuresThe primary predictor was sex. The primary outcome was time to analgesic administration. Secondary outcomes included time to medication order, and the likelihood of receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain score, ED crowding, and triage acuity.ResultsOn adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP women: 112 (65-187) minutes, men: 96 (52-167) minutes, P<0.001] and ordering [women: 84 (41-160) minutes, men: 71 (32-137) minutes, P<0.001], whereas women with FP did not (Administration: P=0.360; Order: P=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR=0.766; 95% CI, 0.670-0.875; P<0.001), whereas women with FP were not (P=0.357).DiscussionIn this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease sex disparities in pain care should take type of pain into account.

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