Impact of Race and Ethnicity on Emergency Medical Services Administration of Opioid Pain Medications for Injured Children

Daniel K Nishijima; Daniel J Tancredi; Kathleen M Adelgais; Kunal Chadha; Todd P Chang; Matthew I Harris; Julie C Leonard; E Brooke Lerner; Seth W Linakis; Geoffrey S Lowe; Christyn F Magill; Hamilton P Schwartz; Manish I Shah; Lorin R Browne

doi:10.1016/j.jemermed.2022.10.011

Impact of Race and Ethnicity on Emergency Medical Services Administration of Opioid Pain Medications for Injured Children

J Emerg Med. 2023 Jan;64(1):55-61. doi: 10.1016/j.jemermed.2022.10.011. Epub 2023 Jan 12.

Authors

Affiliations

¹ Department of Emergency Medicine, University of California, Davis, Sacramento, California. Electronic address: dnishijima@ucdavis.edu.
² Department of Pediatrics, University of California, Davis, Sacramento, California.
³ Departments of Pediatrics and Emergency Medicine, University of Colorado, Aurora, Colorado.
⁴ Department of Pediatrics, University of Buffalo, Buffalo, New York.
⁵ Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California.
⁶ Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine - Hofstra University, New Hyde Park, New York.
⁷ Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio.
⁸ Departments of Emegency Medicine and Pediatrics, University of Buffalo, Buffalo, New York.
⁹ Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.
¹⁰ Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina.
¹¹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
¹² Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
¹³ Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

PMID: 36641254
DOI: 10.1016/j.jemermed.2022.10.011

Abstract

Background: Treatment with analgesics for injured children is often not provided or delayed during prehospital transport.

Objective: Our aim was to evaluate racial and ethnic disparities with the use of opioids during transport of injured children.

Methods: We conducted a prospective study of injured children transported to 1 of 10 emergency departments from July 2019 to April 2020. Emergency medical services (EMS) providers were surveyed about prehospital pain interventions during transport. Our primary outcome was the use of opioids. We performed multivariate regression analyses to evaluate the association of patient demographic characteristics (race, ethnicity, age, and gender), presence of a fracture, EMS provider type (Advanced Life Support [ALS] or non-ALS) and experience (years), and study site with the use of opioids.

Results: We enrolled 465 patients; 19% received opioids during transport. The adjusted odds ratios (AORs) for Black race and Hispanic ethnicity were 0.5 (95% CI 0.2-1.2) and 0.4 (95% CI 0.2-1.3), respectively. The presence of a fracture (AOR 17.0), ALS provider (AOR 5.6), older patient age (AOR 1.1 for each year), EMS provider experience (AOR 1.1 for each year), and site were associated with receiving opioids.

Conclusions: There were no statistically significant associations between race or ethnicity and use of opioids for injured children. The presence of a fracture, ALS provider, older patient age, EMS provider experience, and site were associated with receiving opioids.

Keywords: Disparities; Emergency medical services; Ethnicity; Pain management; Pediatrics; Race.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Analgesics, Opioid / therapeutic use
Child
Emergency Medical Services*
Emergency Service, Hospital
Ethnicity
Fractures, Bone* / drug therapy
Humans
Pain / drug therapy
Prospective Studies

Substances

Analgesics, Opioid