Ethnicity and analgesic practice

doi:10.1016/S0196-0644(00)70099-0

Annals of Emergency Medicine

Volume 35, Issue 1, January 2000, Pages 11-16

Presented at the Society for Academic Emergency Medicine annual meeting, Washington, DC, May 1997.

https://doi.org/10.1016/S0196-0644(00)70099-0 Get rights and content

Abstract

Study Objective: We previously reported that Hispanic ethnicity was an independent risk factor for inadequate analgesic administration among patients presenting to a single emergency department. We then attempted to generalize these findings to other ethnic groups and EDs. Our current study objective is to determine whether black patients with extremity fractures are less likely to receive ED analgesics than similarly injured white patients. Methods: We conducted the following retrospective cohort study at an urban ED in Atlanta, GA. All black and white patients presenting with new, isolated long-bone fractures over a 40-month period were studied. After abstracting demographic information from the medical record and subsequently removing ethnic identifiers, we submitted the medical record to a physician who recorded characteristics of the patients’ injury and treatment. We then submitted the records to a nurse, again blinded to ethnicity, who recorded analgesic administration. We used multiple logistic regression to determine the independent effect of ethnicity on analgesic use while controlling for multiple potential confounders. Our main outcome measure was the proportion of black versus white patients receiving ED analgesics. Results: The study group consisted of 217 patients, of whom 127 were black and 90 were white. White patients were significantly more likely than black patients to receive ED analgesics (74% versus 57%, P =.01) despite similar records of pain complaints in the medical record. The risk of receiving no analgesic while in the ED was 66% greater for black patients than for white patients (relative risk 1.66, 95% confidence interval, 1.11 to 2.50). This effect persisted after controlling for multiple potential confounders. Conclusion: Black patients with isolated long-bone fractures were less likely than white patients to receive analgesics in this ED. No covariate measured in this study could account for this effect. Our findings have implications for efforts to improve analgesic practices for all patients. [Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. January 2000;35:11-16.]

Introduction

Oligoanalgesia, the inadequate prescribing of analgesics for patients in pain, is common among emergency department patients.1, 2, 3 We previously reported that Hispanic patients with extremity fractures were less likely to receive analgesics than similar non-Hispanic white patients in the ED setting.⁴ This disparity in analgesic practice could not be explained by patient characteristics (including gender, language, and insurance status), severity of injury, physician characteristics (including ethnicity, gender, or specialty), or a disparity in physicians’ ability to assess pain between Hispanic and non-Hispanic white patients.⁵

To determine whether our results are generalizable to different EDs and ethnic groups, we conducted a similar retrospective cohort study of analgesic practices comparing black and white ED patients with long-bone fractures.

Section snippets

Materials and methods

The study site was a community, university-affiliated ED serving urban Atlanta, GA. Board-certified emergency physicians staff the ED, although patients are at times seen primarily by their primary care physicians. The study protocol was approved by the Emory University School of Medicine Human Investigations Committee.

ED records were reviewed for a 40-month period (September 1, 1992, through December 31, 1995) to identify all black and white patients discharged from the ED with a diagnosis of

Results

During the 40-month study period, a total of 238 black and white patients were discharged from the ED with diagnoses limited to codes 812, 813, 821, or 823. Of these, 15 cases were secondary presentations of previously treated fractures. In 2 cases, the fracture diagnosis was not confirmed by the radiology report, and in 4 cases, we could not locate the medical record. The remaining 217 patients were included in the study (Figure 1).

. Study exclusions.

The 127 black patients and 90 white patients

Discussion

In this study, approximately two thirds of our patients received analgesics in the ED. This proportion is similar to that of our previous study, which reported ED analgesic administration to 68% of a group of Hispanic and white patients with extremity fractures. Our finding that black patients received analgesics less frequently than white patients is also similar to our previous finding that Hispanic patients received analgesics less often than white patients. Our findings are also consistent

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^☆: Address for reprints: Knox H Todd, MD, MPH, Department of Emergency Medicine, Emory University School of Medicine, 1518 Clifton Road, NE, Room 234, Atlanta, GA 30322; 404-727-9977, fax 404-727-8744; E-mail [email protected].

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Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Am J Emerg Med

Ann Emerg Med

J Emerg Med

J Am Acad Child Adolesc Psychiatry

Pain

J Emerg Med

J Pain Symptom Manage

J Pain Symptom Manage

J Pain Symptom Manage