Racial disparity in analgesic treatment for ED patients with abdominal or back pain
Racial disparity in analgesic treatment for ED patients with abdominal or back pain
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DOI：
10.1016/j.ajem.2010.02.023
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发表时间：
2011-09-01
影响因子：
3.6
通讯作者：
Abbuhl, Stephanie B.
中科院分区：
文献类型：
--
作者：
Mills, Angela M.;Shofer, Frances S.;Abbuhl, Stephanie B.
目的：关于种族如何影响急诊科（艾德）镇痛的研究产生了相互矛盾的结果。我们评估了患者的种族是否影响镇痛给药的患者背部或腹部pain.Methods：这是一个回顾性队列研究的成年人谁提出了2个城市ED背部或腹部疼痛为4年的时间。为了评估种族间镇痛给药和镇痛时间的差异，分别使用Fisher精确和Wilcoxon秩和检验。结果：在20125例患者中（平均年龄42岁，64%为女性，75%为黑人，平均疼痛评分7.5），6218例（31%）有背痛，13907例（69%）有腹痛。总体而言，12109例患者（60%）接受任何镇痛，8475例（42%）接受阿片类药物。比较非白色患者（77%）和白色患者（23%），非白人更可能报告重度疼痛（疼痛评分，9-10）（42%对36%; P < .0001），但更不可能接受任何镇痛（59%对66%; P < .0001），更不可能接受阿片类药物（39%对51%; P < .0001）。在控制了年龄、性别、主诉、分诊分类、入院和严重疼痛后，白色患者接受阿片类药物的可能性仍高出10%（相对危险度，1.10; 95%可信区间，1.06-1.13）。在接受镇痛的患者中，非白人等待阿片类药物镇痛的时间较长（中位时间为98 vs 90 min; P = .004）。结论：在控制了潜在的混杂因素后，因腹部或背部疼痛到艾德就诊的非白人患者接受镇痛的可能性低于白人，并且等待阿片类药物的时间较长。(C)2011 Elsevier Inc. All rights reserved.
Objective: Research on how race affects access to analgesia in the emergency department (ED) has yielded conflicting results. We assessed whether patient race affects analgesia administration for patients presenting with back or abdominal pain.Methods: This is a retrospective cohort study of adults who presented to 2 urban EDs with back or abdominal pain for a 4-year period. To assess differences in analgesia administration and time to analgesia between races, Fisher exact and Wilcoxon rank sum test were used, respectively. Relative risk regression was used to adjust for potential confounders.Results: Of 20 125 patients included (mean age, 42 years; 64% female; 75% black; mean pain score, 7.5), 6218 (31%) had back pain and 13 907 (69%) abdominal pain. Overall, 12 109 patients (60%) received any analgesia and 8475 (42%) received opiates. Comparing nonwhite (77 %) to white patients (23%), nonwhites were more likely to report severe pain (pain score, 9-10) (42% vs 36%; P < .0001) yet less likely to receive any analgesia (59% vs 66%; P < .0001) and less likely to receive an opiate (39% vs 51%; P < .0001). After controlling for age, sex, presenting complaint, triage class, admission, and severe pain, white patients were still 10% more likely to receive opiates (relative risk, 1.10; 95% confidence interval, 1.06-1.13). Of patients who received analgesia, nonwhites waited longer for opiate analgesia (median time, 98 vs 90 minutes; P = .004).Conclusions: After controlling for potential confounders, nonwhite patients who presented to the ED for abdominal or back pain were less likely than whites to receive analgesia and waited longer for their opiate medication. (C) 2011 Elsevier Inc. All rights reserved.