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Emergency Department Pain Management in Children With Appendicitis in a Biethnic Population
Ron Jacob1, Baruch Krauss, Gal Twito
1*Emergency Department, Ruth Children's Hospital §Quality of Care Unit, Rambam Health Care Campus ‡Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel †Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Emergency department analgesia for acute appendicitis in children is low, with no ethnic disparities observed. Pain scores and triage acuity influenced administration, but ethnicity did not affect treatment.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Health Disparities Research
Background:
- Acute appendicitis is a common surgical emergency in children.
- Effective pain management in the emergency department (ED) is crucial for patient comfort and care.
- Previous studies suggest potential ethnic variations in healthcare delivery, including pain management.
Purpose of the Study:
- To investigate factors influencing the administration of analgesia, including opioid analgesia, for acute appendicitis in pediatric ED patients.
- To examine potential ethnic differences in analgesia provision between Jewish and Arab children.
- To assess the impact of patient-nurse ethnicity concordance on analgesia administration.
Main Methods:
- Retrospective cohort study of children diagnosed with acute appendicitis (ICD-9).
- Analysis of factors associated with any analgesia and opioid analgesia administration.
- Multivariate regression models to evaluate the effect of ethnicity and patient-nurse concordance, adjusting for clinical variables.
Main Results:
- Of 715 children with appendicitis, 40.4% received any analgesia and 19.4% received opioid analgesia.
- Higher pain scores and triage acuity were significantly associated with receiving analgesia.
- After adjustment, Jewish and Arab children had similar likelihoods of receiving any analgesia (41.8% vs. 40.7%) and opioid analgesia (26.1% vs. 25.3%).
- Patient-nurse ethnicity concordance did not influence analgesia administration.
Conclusions:
- Low rates of analgesia and opioid administration were observed in children with acute appendicitis.
- No significant ethnic differences were found in the provision of analgesia.
- Pain scores and triage acuity are key determinants of analgesia, independent of ethnicity.
Objectives:
Our goal was to examine factors associated with the administration of emergency department analgesia (any analgesia, opioid analgesia) in patients with acute appendicitis in a tertiary children's hospital in Israel, and to examine ethnic differences.
Methods:
A retrospective cohort study of children evaluated in the emergency department, who had International Classification Of Disease-Ninth Revision (ICD-9) diagnosis of acute appendicitis. Regression analysis was used to test the effect of multiple variables on the provision of analgesia. Medications were administered according to a nurse-driven pain protocol. Multivariate regression was performed to estimate the strength of association between ethnicity and provision of analgesia. The effect of patient-nurse ethnicity concordance was assessed.
Results:
During the 6-year study period, there were 715 children with acute appendicitis, 457 Jews and 258 Arabs. Overall, 289 (40.4%) received some form of analgesia, and 139 (19.4%) received opioid analgesia. Univariate analysis revealed that higher pain score (P<0.001) and higher triage acuity (P<0.001) were associated with administration of any type of analgesia and of opioid analgesia. When adjusted for age, weight, sex, triage category, pain score, and 24-hour time of arrival, Jewish and Arab patients had similar likelihood of receiving analgesia of any type 41.8% (95% confidence interval [CI], 40.3%-43.3%) versus 40.7% (95% CI, 38.7%-42.8%), and receiving opioid analgesia 26.1% (95% CI, 24.4%-27.8%) versus 25.3% (95% CI, 22.9%-27.7%). Similar proportions of Jewish and Arab patients received analgesia from Jewish and Arab nurses.
Conclusions:
Low rates of analgesia and opioid administration were found with no ethnic differences.
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