Racial and Gender-Based Disparities in Opioid Administration for Ocular Trauma

Area of Science:

• Emergency Medicine
• Ophthalmology
• Health Equity

Background:

• Opioid administration for pain management in prehospital settings is common.
• Open globe injuries (OGIs) are severe ocular emergencies requiring prompt pain relief.
• Social determinants of health (SDOH) may influence treatment disparities.

Purpose of the Study:

• To investigate how race and other SDOH impact prehospital opioid use for OGIs in the US.
• To identify factors associated with opioid administration in OGI cases.
• To analyze potential disparities in pain management for ocular trauma.

Main Methods:

• Analysis of National Emergency Medical Services Information System (NEMSIS) data (2017-2021).
• Inclusion of emergency medical service activations for OGIs, excluding cancellations and non-contact cases.
• Multivariate logistic regression adjusted for pain scores to determine factors influencing opioid administration.

Main Results:

• Among 53,589 OGI cases, females (OR 0.71) and non-White patients (African Americans OR 0.37; Hispanics OR 0.83) were less likely to receive opioids.
• Urban patients (OR 0.63) and those in the Midwest (OR 0.75), Northeast (OR 0.24), and South (OR 0.77) received fewer opioids compared to suburban and Western regions.
• Emergent cases (OR 1.85) and older adults (66-75 years, OR 1.41) were more likely to receive opioids.

Conclusions:

• Significant racial, regional, and gender disparities exist in prehospital opioid administration for OGIs.
• Addressing implicit bias and diversifying the EMS workforce are crucial.
• Clearer guidelines are needed to ensure equitable pain management for ocular trauma patients.