Acute Pain Service Utilization as a Lens on Inequities in Trauma and Inpatient Management

Area of Science:

• Pain Management
• Health Equity
• Health Services Research

Background:

• Inequities in pain management are documented in chronic pain and outpatient settings, but disparities in inpatient Acute Pain Service (APS) care are less understood.
• This study examines demographic, clinical, and social factors influencing APS utilization and outcomes at an urban safety-net hospital.
• A subgroup analysis focused on trauma patients with multiple rib fractures and their APS consult status.

Purpose of the Study:

• To evaluate factors associated with Acute Pain Service (APS) utilization and patient outcomes in an urban safety-net hospital.
• To identify demographic, clinical, and social predictors of APS consultation.
• To analyze disparities in APS care, particularly among vulnerable patient groups and trauma patients.

Main Methods:

• Retrospective cohort study of 1445 APS consultations and 650 rib fracture patients from January 2020 to November 2022.
• Analysis included demographics, insurance status, comorbidities, opioid prescribing, and discharge outcomes.
• Statistical methods included descriptive statistics, multivariable logistic regression, and log-linear models to identify significant predictors.

Main Results:

• Patients receiving APS care were disproportionately from vulnerable groups: 30.5% Black, 81.0% publicly insured, 32.9% with substance use disorder (SUD).
• Methadone use predicted non-home discharge. In rib fracture patients, APS consults correlated with higher injury severity.
• Black patients were less likely to receive APS consults, linked to younger age and male predominance, which were predictors of consultation.

Conclusions:

• APS utilization at safety-net hospitals reflects the intersection of medical vulnerability and structural inequities.
• Vulnerable populations, including racial/ethnic minorities, publicly insured, and those with SUD, showed greater APS involvement.
• Findings highlight the need for standardized APS criteria and integration of social support and addiction medicine resources to address care gaps.