Related Experiment Video
Updated: May 23, 2025
Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography
Published on: November 29, 2017
Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported Via EMS
Sarahjean Kerolle1, Lorin R Browne2, Ruta Brazauskas3
1Department of Emergency Medicine, The University of Texas Medical Branch, Galveston, TX.
Insights
Racial and ethnic disparities exist in the timing of emergency department (ED) pain management for injured children arriving via emergency medical services (EMS). While all children eventually received pain medication, Hispanic children experienced delays in receiving any analgesia, unlike opioid analgesia.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Disparities
Background:
- Pain management in emergency settings is often suboptimal.
- Racial and ethnic disparities in pediatric pain management are not well understood.
- Emergency Medical Services (EMS) transport to pediatric Emergency Departments (EDs) is a critical juncture for analgesia administration.
Purpose of the Study:
- To investigate racial and ethnic disparities in the timing of pain management for injured children transported by EMS to pediatric EDs.
- To analyze differences in the administration of analgesia based on race and ethnicity.
Main Methods:
- Secondary analysis of a multicenter prospective observational study.
- Inclusion of 480 injured children transported by EMS to 10 pediatric EDs.
- Analysis of analgesia timing stratified by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Other/Multiracial) and medication type (opioids, non-opioids).
Main Results:
- Hispanic children experienced a longer median time to the first dose of any ED analgesia (55 minutes) compared to other racial/ethnic groups.
- No significant differences were found in the time to the first dose of opioid analgesia by race or ethnicity.
- Factors such as long bone fractures and prior EMS opioid administration were associated with receiving ED analgesia.
Conclusions:
- Significant race and ethnicity differences exist in the time to receive any analgesia for injured children in the ED after EMS transport.
- No delays in ED opioid analgesia administration were observed based on race or ethnicity.
- Further research is necessary to identify and address the root causes of these observed disparities in pain management timing.
Objectives:
Pain management remains suboptimal across the prehospital and the emergency department (ED) settings. Racial and ethnic disparities in the timing of analgesia among children transported to EDs via emergency medical services (EMS) are not known. We investigated disparities in the timing of ED pain management for injured children transported by EMS.
Methods:
We conducted a secondary analysis of a multicenter prospective observational study of children transported via EMS to 10 pediatric EDs. We analyzed the timing of ED analgesia for injured children by race and ethnicity: non-Hispanic White (NH-White), non-Hispanic Black (NH-Black), Hispanic, and Other or Multiracial. We stratified doses of ED analgesia by opioids, nonopioids, nonsteroidal anti-inflammatory drugs, and other analgesic medications regardless of routes of administration.
Results:
Among 480 eligible injured children, 353 (73.5%) received ED analgesia and 150 (31.3%) received opioid analgesia in the ED after EMS transport. The median time to first administration of any ED analgesia was 39 minutes (range, 2 min to 6 h). Hispanic children received their first dose of any ED analgesia 55 minutes (minimum-maximum, 2 to 369) into their ED care, compared with 38 minutes (4 to 379) for NH-Black, 37 minutes (4 to 345) for NH-White, and 32 minutes (9 to 188) for children of Other or Multiracial groups ( P =0.0148). There were no statistical differences in the time to first ED opioid analgesia by race and ethnicity ( P =0.3270). Patients with long bone fractures (hazard ratio: 1.56, 1.18-2.06) and those who had received EMS opioids (1.43, 1.07-1.91) were more likely to receive both any analgesia and opioid analgesia in the ED.
Conclusions:
Among injured children across the country transported by EMS to pediatric EDs, there were race and ethnicity differences with respect to time to any ED analgesia; however, no delay for ED opioids. Further research is needed to understand and mitigate potential root causes of these disparities.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:24Local Anesthetics: Differential Sensitivity of Nerve Fibers
01:24Parenteral Anesthetics: Overview
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
One of the advantages of...
01:13Local Anesthetics: Pharmacokinetics