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      Prehospital Pain Management: Disparity By Age and Race

      Author(s): , , , ,
      Publication date Created:
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      Journal: Prehospital Emergency Care
      Publisher: Informa UK Limited

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          Abstract

          Historically, pain management in the prehospital setting, specifically pediatric pain management, has been inadequate despite many EMS (emergency medical services) transports related to traumatic injury with pain noted as a symptom. The National Emergency Services Information System (NEMSIS) database offers the largest national repository of prehospital data, and can be used to assess current patterns of EMS pain management across the country.

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          Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.

          Mark J Pletcher, Ralph Gonzales, Mark J Pletcher … (2008)
          National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased. To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000. Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey. Prescription of an opioid analgesic. Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93). Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished.
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            Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments.

            Monika Goyal, Nathan Kuppermann, Sean D. Cleary … (2015)
            Racial disparities in use of analgesia in emergency departments have been previously documented. Further work to understand the causes of these disparities must be undertaken, which can then help inform the development of interventions to reduce and eradicate racial disparities in health care provision.
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              Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States.

              Salimah Meghani, Eeeseung Byun, Rollin M Gallagher (2012)
              The recent Institute of Medicine Report assessing the state of pain care in the United States acknowledged the lack of consistent data to describe the nature and magnitude of unrelieved pain and identify subpopulations with disproportionate burdens.
              Article 0 comments Cited 115 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Prehospital Emergency Care
                Abbreviated Title: Prehospital Emergency Care
                Publisher: Informa UK Limited
                ISSN (Print): 1090-3127
                ISSN (Electronic): 1545-0066
                Publication date Created: September 28 2017
                Publication date Created: March 04 2018
                Publication date (Electronic): September 28 2017
                Publication date (Print): March 04 2018
                Volume: 22
                Issue: 2
                Pages: 189-197
                Article
                DOI: 10.1080/10903127.2017.1367444
                PubMed ID: 28956669
                SO-VID: a6a42505-4c51-479b-822f-2e6f65897c7d
                Copyright © © 2018
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