Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain
Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain
复制标题
DOI：
10.1111/j.1553-2712.2008.00100.x
复制
发表时间：
2008-05-01
影响因子：
4.4
通讯作者：
Mills, Angela M.
中科院分区：
文献类型：
--
作者：
Chen, Esther H.;Shofer, Frances S.;Mills, Angela M.
目的：对于急性腹痛的寡效止痛历来被归因于提供者害怕掩盖严重的潜在病理。作者评估了急性腹痛的止痛用药是否存在性别差异。方法：这是一项前瞻性队列研究，研究对象为2004年4月5日至2005年1月4日在城市急诊科就诊的连续非妊娠成人，他们的急性非创伤性腹痛持续时间小于72小时。主要观察指标为止痛用药和止痛治疗时间。结果：在入选的981名患者中(平均年龄+/-标准差[SD]41+/-17岁；女性占65%)，62%的患者接受过止痛治疗。男性和女性的平均疼痛评分相似，但女性接受任何止痛药的可能性较低(60%比67%，差异7%，95%可信区间=1.1%至13.6%)，更不可能接受阿片类药物(45%比56%，差异11%，95%CI=4.1%至17.1%)。当排除性别诊断时，这些差异仍然存在(47%对56%，差异9%，95%CI=2.5%至16.2%)。在控制了年龄、种族、分类和疼痛评分后，女性接受阿片类止痛药的可能性仍然比男性低13%到25%。在接受非阿片类止痛药方面没有性别差异。女性等待止痛的时间更长(中位时间65分钟比49分钟，相差16分钟，95%CI=3.5~33分钟)。结论：性别偏见可能是急腹症患者出现少痛的原因之一。标准化的止痛药给药方案可能会改善这种差异。
Objectives: Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain.Methods: This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used.Results: Of the 981 patients enrolled (mean age +/- standard deviation [SD] 41 +/- 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes).Conclusions: Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy.