copyright restrictions may apply jama pediatrics journal club slides: racial disparities in pain...
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JAMA Pediatrics Journal Club Slides:Racial Disparities in Pain
Management for Appendicitis
Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. Published online September 14, 2015. doi:10.1001/jamapediatrics.2015.1915.
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• Background– Racial/ethnic disparities in the management of abdominal pain in
emergency departments (EDs) have been reported. However, these studies may be affected by spectrum bias and may reflect racial/ethnic differences in ED use rather than true differences in pain management.
– Appendicitis is the most common surgical cause of abdominal pain in children in the ED, and provision of analgesia is considered the standard of care.
• Study Objective– To investigate racial differences in analgesia administration among
children diagnosed as having appendicitis in the ED.
Introduction
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• Study Design– Repeated cross-sectional study of the National Hospital Ambulatory
Medical Care Survey from 2003 to 2010.
• Setting– Nationally representative sample of EDs.
• Patients– Children aged 21 years or younger diagnosed as having appendicitis
(International Classification of Diseases, Ninth Revision codes 540, 541).
Methods
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Methods
• Outcomes– Racial differences in the following:
(1) Any analgesia administration.(2) Opioid administration.
• Limitations– No documentation if analgesia was offered but declined by patients.– Only pain scores at triage were abstracted.– Cannot account for analgesia received prior to ED arrival.– Race/ethnicity data determined by someone other than the patient.
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Results
Demographic Characteristics of Study Population
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Results
Multivariable Analysis of Overall Analgesia and Opioid Administration by Racea
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ResultsPredicted Probabilities for Analgesic and Opioid Administration by Race
Stratified by Pain Score and Adjusted for Ethnicity
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Comment
• Appendicitis pain is undertreated in children.– Only 56.8% of children diagnosed as having appendicitis in the ED
received any analgesia.– Only 41.3% received opioid analgesia.
• No racial differences were found in analgesia administration overall.
• Black children were less likely to receive opioid analgesia than white children even after adjustment for pain score and triage level.– Adjusted odds ratio = 0.2 (95% CI, 0.06-0.8).
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• If you have questions, please contact the corresponding author:– Monika K. Goyal, MD, MSCE, Children’s National Health System,
111 Michigan Ave NW, Washington, DC 20010 ([email protected]).
Funding/Support• This work was supported by grant K23 HD070910 from the National
Institutes of Health (Dr Goyal).
Conflict of Interest Disclosures• None reported.
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