0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Journal Club

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

Monika K. Goyal, MD, MSCE1,2,3; Nathan Kuppermann, MD, MPH4,5; Sean D. Cleary, PhD, MPH6; Stephen J. Teach, MD, MPH1,2,3; James M. Chamberlain, MD1,2,3
[+] Author Affiliations
1Children’s National Health System, Washington, DC
2Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
3Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
4Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento
5Department of Pediatrics, University of California Davis School of Medicine, Sacramento
6Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC
JAMA Pediatr. 2015;169(11):996-1002. doi:10.1001/jamapediatrics.2015.1915.
Text Size: A A A
Published online

Importance  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.

Objective  To evaluate racial differences in analgesia administration, and particularly opioid administration, among children diagnosed as having appendicitis.

Design, Setting, and Participants  Repeated cross-sectional study of patients aged 21 years or younger evaluated in the emergency department who had an International Classification of Diseases, Ninth Revision diagnosis of appendicitis, using the National Hospital Ambulatory Medical Care Survey from 2003 to 2010. We calculated the frequency of both opioid and nonopioid analgesia administration using complex survey weighting. We then performed multivariable logistic regression to examine racial differences in overall administration of analgesia, and specifically opioid analgesia, after adjusting for important demographic and visit covariates, including ethnicity and pain score.

Main Outcomes and Measures  Receipt of analgesia administration (any and opioid) by race.

Results  An estimated 0.94 (95% CI, 0.78-1.10) million children were diagnosed as having appendicitis. Of those, 56.8% (95% CI, 49.8%-63.9%) received analgesia of any type; 41.3% (95% CI, 33.7%-48.9%) received opioid analgesia (20.7% [95% CI, 5.3%-36.0%] of black patients vs 43.1% [95% CI, 34.6%-51.4%] of white patients). When stratified by pain score and adjusted for ethnicity, black patients with moderate pain were less likely to receive any analgesia than white patients (adjusted odds ratio = 0.1 [95% CI, 0.02-0.8]). Among those with severe pain, black patients were less likely to receive opioids than white patients (adjusted odds ratio = 0.2 [95% CI, 0.06-0.9]). In a multivariable model, there were no significant differences in the overall rate of analgesia administration by race. However, black patients received opioid analgesia significantly less frequently than white patients (12.2% [95% CI, 0.1%-35.2%] vs 33.9% [95% CI, 0.6%-74.9%], respectively; adjusted odds ratio = 0.2 [95% CI, 0.06-0.8]).

Conclusions and Relevance  Appendicitis pain is undertreated in pediatrics, and racial disparities with respect to analgesia administration exist. Black children are less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain, suggesting a different threshold for treatment.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Predicted Probabilities for Analgesic and Opioid Administration by Race Stratified by Pain Score and Adjusted for Ethnicity

A, Moderate pain. B, Severe pain.

aStatistically significant difference in administration (P < .05).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Adjusted Predicted Probabilities for Analgesia and Opioid Administration by Race Over Time

A, Any analgesia. B, Opioid analgesia. Adjusted for ethnicity, age, sex, insurance status, triage level, and pain score.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

8,071 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Appendicitis, Adult

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Appendicitis, Child

brightcove.createExperiences();