Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population - 19/12/15
, Eliaz Brumer, MD b, Danielle Shavit d, Mark Eidelman, MD c, Ivan P. Steiner, MD e, Carmit Steinberg, MA aAbstract |
Study objective |
We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation.
Methods |
A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol.
Results |
During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval –0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval –16% to 18%).
Conclusion |
Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED.
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| Please see page 10 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kelly D. Young, MD, MS |
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| Author contributions: IS and ME conceived the idea for the study. IS designed the study, performed the statistical analysis, and drafted the article. EB and DS collected the data. IS, EB, IPS, and CS analyzed the data. EB, DS, ME, IPS, and CS reviewed the article and approved the final version. DS designed the data collection instrument. ME contributed to interpretation of the study results. IPS and CS critically revised the article. CS coordinated and supervised data collection. All authors approved the final article and agree to be accountable for all aspects of the work. IS takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
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| Clinical trial registration number: NCT02322463 |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 67 - N° 1
P. 9 - janvier 2016 Retour au numéro
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