Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain

Chen, Esther H.; Shofer, Frances S.; Dean, Anthony J.; Hollander, Judd E.; Baxt, William G.; Robey, Jennifer L.; Sease, Keara L.; Mills, Angela M.

doi:10.1111/j.1553-2712.2008.00100.x

Cited by 253 publications

(181 citation statements)

References 35 publications

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“…[1][2][3] Optimal pain management is lacking in most EDs, as many patients do not receive analgesia [3][4][5][6][7][8][9][10][11][12] and time to analgesic administration is often too long. 3,[5][6][7][8][10][11][12][13][14][15][16][17][18][19] Most health care professionals underestimate pain intensity.…”

Section: Introductionmentioning

confidence: 99%

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

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Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain. Methods: We performed a retrospective analysis of real-time, archived data from an electronic medical record system at an urban teaching hospital and regional community hospital. We included consecutive ED patients ≥16 years old who had a self-reported pain intensity ≥1 as measured during triage, from March 2005 to December 2012. The primary outcome was vital signs for self-reported pain intensity levels (mild, moderate, severe) on an 11-point verbal numerical scale. Changes in pain intensity levels were also compared to variations in vital signs. Both analyses were repeated on a subgroup of patients with diagnosed conditions recognized to produce significant pain: fracture, dislocation, or renal colic. Results: We included 153,567 patients (mean age of 48.4 ± 19.3 years; 55.5% women) triaged with pain (median intensity of 7/10 ± 3). Of these, 8.9% of patients had diagnosed conditions recognized to produce significant pain. From the total sample, the difference between mild and severe pain categories was 2.7 beats/minutes (95% CI: 2.4 − 3.0) for heart rate and 0.13 mm Hg (95% CI: -0.26 − 0.52) for systolic blood pressure. These differences generated small effect sizes and were not clinically significant. Results were similar for patients who experienced changes in pain categories and for those conditions recognized to produce significant pain. Conclusion: Health care professionals cannot use vital signs to estimate or substantiate self-reported pain intensity levels or changes over time. RÉSUMÉObjectif: L'étude visait à confirmer l'existence d'une association entre l'intensité de la douleur autodéclarée et les signes vitaux enregistrés chez des patients au service des urgences (SU) ainsi que dans un sous-groupe de malades souffrant d'affections connues pour causer de fortes douleurs. Méthode: Les auteurs ont procédé à une analyse rétro-spective de données enregistrées en temps réel et archivées dans un système de dossiers médicaux électroniques, dans un centre hospitalier universitaire urbain et dans un hôpital communautaire régional. Ont participé à l'étude des patients consécutifs, âgés de ≥16 ans, qui ont fait état, au SU, de douleurs d'une intensité ≥1, mesurée durant le triage, de mars 2005 à décembre 2012. Le principal critère d'évaluation était les signes vitaux associés à différents degrés d'intensité (légère, modérée, forte) de la douleur autodéclarée sur une échelle numérique, verbale, de 11 points. Les variations de l'intensité de la douleur ont également été comparées aux variations des signes vitaux. Les deux analyses ont été reprises dans un sous-groupe de patients souffrant d'affections connues pour causer de fortes douleurs: fracture, luxation ou colique néphrétique. Résultats: Ont participé à l'étude 153 567 patients (âge moyen: 48,4 ± 19,3 ans; femm...

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Section: Introductionmentioning

confidence: 99%

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

View full text Add to dashboard Cite

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“…[12][13][14] In emergency department (ER) and primary care visits for pain, studies have demonstrated that African Americans and women are less likely to receive opioids for acute pain. 12,[15][16][17] These racial differences are thought to contribute to the disproportionate effect of the opioid epidemic on the white population. 18 The influence of the social determinants of health cannot be fully explored without addressing socioeconomic status (SES).…”

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confidence: 99%

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

2017

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Background: Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations.Objective: Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics.Methods: This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry. Eligibility criteria included age >18 years, free of HIV and cancer, and presenting to primary care with a new diagnosis of back pain, resulting in1646 patients included. Patients' nSES was determined using ZIP code and calculating a validated index of 7 census-tract variables. Multinomial logistic regression was used to measure the association between nSES and 3 treatment outcomes compared with no pharmacologic management. Outcomes included opioid prescription, nonsteroidal anti-inflammatory (NSAID)/muscle relaxant prescription, or combined opioid/nonopioid treatment within 90 days of initial presentation. Covariates included age, sex, race, high clinic utilization (HCU), depression, anxiety, substance use, obesity, comorbidities, smoking, number of pain conditions, and physical therapy (PT) referral. Results: The cohort was 67.9% female with an average age of 55.72 years (Standard Error [SE] ‫؍‬ 0.387). Compared with no pharmacologic treatment, individuals in the low nSES group had 63% higher odds of receiving an opioid only compared with the high nSES group (odds ratio [OR

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“…Young age (,2 years) and female gender are also linked with ED oligoanalgesia, and therefore were adjusted for in our models. 13,14 Patients' pain and triage level at presentation are clinical factors that can influence diagnostic test ordering and administration of analgesics. 15,16 Pain was measured on a 10-point scale and grouped into 4 categories: none (0), mild (1-3), moderate (4-6), and severe (7)(8)(9)(10) 17 For our analyses, we collapsed triage level into 3 groups: immediate or emergent, urgent, and semiurgent or nonurgent.…”

Section: Covariatesmentioning

confidence: 99%

Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Racial/ethnic differences in care for adult and pediatric patients in the emergency department have been documented. WHAT THIS STUDY ADDS:This study reveals racial/ethnic differences in analgesic administration and prolonged length of stay for pediatric emergency department visits for abdominal pain. Documenting such disparities is an important first step needed to improve the equity of care for this and other conditions. abstract OBJECTIVE: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs). METHODS: Secondary analysis of data from the 2006-2009 NationalHospital Ambulatory Medical Care Survey regarding 2298 visits by patients #21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as $7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission. RESULTS:Of patient visits, 70.1% were female, 52.6% were from nonHispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from "other" racial/ethnic groups; patients' mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio CONCLUSIONS: Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care.[

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Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain

Cited by 253 publications

References 35 publications

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department

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