Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population

• Published in: Annals of emergency medicine 2016-01, Vol.67 (1), p.9-14.e1
• Main Authors: Shavit, Itai, MD, Brumer, Eliaz, MD, Shavit, Danielle, Eidelman, Mark, MD, Steiner, Ivan P., MD, Steinberg, Carmit, MA
• Format: Article
• Language: English
• Subjects: Adolescent; Analgesics, Opioid - therapeutic use; Arabs - statistics & numerical data; Child; Child, Preschool; Emergency; Emergency Service, Hospital - organization & administration; Female; Fractures, Bone - complications; Fractures, Bone - ethnology; Humans; Israel; Jews - statistics & numerical data; Joint Dislocations - complications; Joint Dislocations - ethnology; Male; Pain Management - methods; Pain Measurement; Retrospective Studies
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2015.07.497

Study objective We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation. Methods A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol. Results During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval –0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval –16% to 18%). Conclusion Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED.