VanderBeek Brian L, Mehlman Charles T, Foad Susan L, Wall Eric J, Crawford Alvin H
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
J Pediatr Orthop. 2006 Jan-Feb;26(1):53-7. doi: 10.1097/01.bpo.0000187993.17387.09.
Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.
医学文献中的近期报告表明，在医疗保健领域已发现某些种族差异。作者试图确定接受前臂骨折复位的非裔美国儿童和白人儿童使用止痛药物之间的潜在关系。这项回顾性队列研究在一家大学附属的三级护理儿童医院急诊科进行。纳入了在2年观察期内接受尺骨或桡骨闭合复位的所有白人和非裔美国患者。如果患者因切开复位入院或有多处损伤，则被排除在研究之外。分析了种族、性别、保险状况、入院时间、在急诊科的住院时间、骨折特征以及使用清醒镇静之间的关系。采用t检验、卡方检验和逐步逻辑回归进行数据分析。总共纳入了503例患者，其中83%为白人，17%为非裔美国人。404例患者在骨折复位过程中接受了清醒镇静，99例未接受。单因素分析显示，非裔美国儿童和白人儿童的前臂骨折模式不同（P = 0.0116），成角严重程度不同（P = 0.0094）。多变量统计分析显示，骨折移位量较大（P < 0.0001）、成角（P < 0.0027）以及患者年龄较小（P = 0.0059）是使用清醒镇静的显著预测因素。未发现种族与使用清醒镇静有显著关联（单因素分析中P = 0.0606，多变量分析中P = 0.1678）。作者发现，小儿前臂骨折使用清醒镇静的决定不受种族影响，而是受某些骨折特征和患者年龄影响。
