Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Am J Emerg Med. 2011 Sep;29(7):752-6. doi: 10.1016/j.ajem.2010.02.023. Epub 2010 May 1.
Research on how race affects access to analgesia in the emergency department (ED) has yielded conflicting results. We assessed whether patient race affects analgesia administration for patients presenting with back or abdominal pain.
This is a retrospective cohort study of adults who presented to 2 urban EDs with back or abdominal pain for a 4-year period. To assess differences in analgesia administration and time to analgesia between races, Fisher exact and Wilcoxon rank sum test were used, respectively. Relative risk regression was used to adjust for potential confounders.
Of 20,125 patients included (mean age, 42 years; 64% female; 75% black; mean pain score, 7.5), 6218 (31%) had back pain and 13,907 (69%) abdominal pain. Overall, 12,109 patients (60%) received any analgesia and 8475 (42%) received opiates. Comparing nonwhite (77 %) to white patients (23%), nonwhites were more likely to report severe pain (pain score, 9-10) (42% vs 36%; P < .0001) yet less likely to receive any analgesia (59% vs 66%; P < .0001) and less likely to receive an opiate (39% vs 51%; P < .0001). After controlling for age, sex, presenting complaint, triage class, admission, and severe pain, white patients were still 10% more likely to receive opiates (relative risk, 1.10; 95% confidence interval, 1.06-1.13). Of patients who received analgesia, nonwhites waited longer for opiate analgesia (median time, 98 vs 90 minutes; P = .004).
After controlling for potential confounders, nonwhite patients who presented to the ED for abdominal or back pain were less likely than whites to receive analgesia and waited longer for their opiate medication.
关于种族如何影响急诊科（ED）获得镇痛剂的研究结果相互矛盾。我们评估了患者的种族是否会影响腰痛或腹痛患者接受镇痛治疗。
这是一项回顾性队列研究，纳入了 4 年来在 2 家城市 ED 因腰痛或腹痛就诊的成年人。为了评估种族间镇痛剂给药和镇痛剂起效时间的差异，分别使用 Fisher 精确检验和 Wilcoxon 秩和检验。使用相对危险回归来调整潜在混杂因素。
共纳入 20125 例患者（平均年龄 42 岁；64%为女性；75%为黑人；平均疼痛评分 7.5），6218 例（31%）为腰痛，13907 例（69%）为腹痛。总体而言，12109 例（60%）患者接受了任何镇痛剂，8475 例（42%）患者接受了阿片类药物。与白人患者（23%）相比，非白人患者（77%）更有可能报告重度疼痛（疼痛评分 9-10）（42%比 36%；P<0.0001），但接受任何镇痛剂的可能性较低（59%比 66%；P<0.0001），接受阿片类药物的可能性较低（39%比 51%；P<0.0001）。在校正年龄、性别、就诊主诉、分诊级别、入院和重度疼痛后，白人患者接受阿片类药物的可能性仍高出 10%（相对风险 1.10；95%置信区间 1.06-1.13）。在接受镇痛剂的患者中，非白人患者等待阿片类药物镇痛的时间更长（中位数时间，98 分钟比 90 分钟；P=0.004）。
在校正潜在混杂因素后，因腰痛或腹痛就诊 ED 的非白人患者接受镇痛治疗的可能性低于白人患者，且等待阿片类药物的时间更长。
