Shah Adil A, Zogg Cheryl K, Zafar Syed Nabeel, Schneider Eric B, Cooper Lisa A, Chapital Alyssa B, Peterson Susan M, Havens Joaquim M, Thorpe Roland J, Roter Debra L, Castillo Renan C, Salim Ali, Haider Adil H
*Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health and the Department of Surgery, Brigham & Women's Hospital, Boston, MA †Division of General Surgery, Mayo Clinic, Phoenix, AZ ‡Department of Surgery, Howard University Hospital, Washington, DC §Division of General Internal Medicine ∥Department of Emergency Medicine, The Johns Hopkins University School of Medicine ¶The Johns Hopkins Center on Aging and Health Departments of #Health, Behavior, and Society **Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2015 Dec;53(12):1000-9. doi: 10.1097/MLR.0000000000000444.
Prior studies of acute abdominal pain provide conflicting data regarding the presence of racial/ethnic disparities in the emergency department (ED).
To evaluate race/ethnicity-based differences in ED analgesic pain management among a national sample of adult patients with acute abdominal pain based on a uniform definition.
RESEARCH DESIGN/SUBJECTS/MEASURES: The 2006-2010 CDC-NHAMCS data were retrospectively queried for patients 18 years and above presenting with a primary diagnosis of nontraumatic acute abdominal pain as defined by the American Association for the Surgery of Trauma. Independent predictors of analgesic/narcotic-specific analgesic receipt were determined. Risk-adjusted multivariable analyses were then performed to determine associations between race/ethnicity and analgesic receipt. Stratified analyses considered risk-adjusted differences by the level of patient-reported pain on presentation. Secondary outcomes included: prolonged ED-LOS (>6 h), ED wait time, number of diagnostic tests, and subsequent inpatient admission.
A total of 6710 ED visits were included: 61.2% (n=4106) non-Hispanic white, 20.1% (n=1352) non-Hispanic black, 14.0% (n=939) Hispanic, and 4.7% (n=313) other racial/ethnic group patients. Relative to non-Hispanic white patients, non-Hispanic black patients and patients of other races/ethnicities had 22%-30% lower risk-adjusted odds of analgesic receipt [OR (95% CI)=0.78 (0.67-0.90); 0.70 (0.56-0.88)]. They had 17%-30% lower risk-adjusted odds of narcotic analgesic receipt (P<0.05). Associations persisted for patients with moderate-severe pain but were insignificant for mild pain presentations. When stratified by the proportion of minority patients treated and the proportion of patients reporting severe pain, discrepancies in analgesic receipt were concentrated in hospitals treating the largest percentages of both.
Analysis of 5 years of CDC-NHAMCS data corroborates the presence of racial/ethnic disparities in ED management of pain on a national scale. On the basis of a uniform definition, the results establish the need for concerted quality-improvement efforts to ensure that all patients, regardless of race/ethnicity, receive optimal access to pain relief.
先前关于急性腹痛的研究在急诊科（ED）是否存在种族/民族差异方面提供了相互矛盾的数据。
基于统一的定义，评估全国范围内成年急性腹痛患者样本中，急诊科镇痛疼痛管理方面基于种族/民族的差异。
研究设计/研究对象/测量指标：对2006 - 2010年疾病控制与预防中心 - 国家医院门诊医疗调查（CDC - NHAMCS）数据进行回顾性查询，以获取18岁及以上、以美国创伤外科协会定义的非创伤性急性腹痛为主要诊断的患者信息。确定了接受镇痛/特定麻醉镇痛药物的独立预测因素。然后进行风险调整后的多变量分析，以确定种族/民族与镇痛药物接受情况之间的关联。分层分析考虑了根据患者就诊时报告的疼痛程度进行风险调整后的差异。次要结局包括：急诊留观时间延长（>6小时）、急诊等待时间、诊断检查次数以及随后的住院情况。
共纳入6710次急诊就诊病例：非西班牙裔白人占61.2%（n = 4106），非西班牙裔黑人占20.1%（n = 1352），西班牙裔占14.0%（n = 939），其他种族/民族患者占4.7%（n = 313）。相对于非西班牙裔白人患者，非西班牙裔黑人患者及其他种族/民族患者接受镇痛药物的风险调整后几率低22% - 30%[比值比（95%置信区间）= 0.78（0.67 - 0.90）；0.70（0.56 - 0.88）]。他们接受麻醉性镇痛药物的风险调整后几率低17% - 30%（P < 0.05）。对于中重度疼痛患者，这种关联持续存在，但对于轻度疼痛患者则不显著。按接受治疗的少数族裔患者比例和报告严重疼痛的患者比例进行分层时，镇痛药物接受情况的差异集中在同时治疗这两类患者比例最高的医院。
对5年的CDC - NHAMCS数据进行分析证实，在全国范围内急诊科疼痛管理中存在种族/民族差异。基于统一的定义，研究结果表明需要齐心协力进行质量改进，以确保所有患者，无论种族/民族如何，都能获得最佳的疼痛缓解治疗。
