Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Pediatric Urology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, USA.
Am J Emerg Med. 2021 Jan;39:71-74. doi: 10.1016/j.ajem.2020.01.017. Epub 2020 Jan 8.
We sought quantify racial disparities in use of analgesia amongst patients seen in Emergency Departments for renal colic.
We identified all individuals presenting to the Emergency Department with urolithiasis from 2003 to 2015 in the nationally representative Premier Hospital Database. We included patients discharged in ≤1 day and excluded those with chronic pain or renal insufficiency. We assessed the relationship between race/ethnicity and opioid dosage in morphine milligram equivalents (MME), and ketorolac, through multivariable regression models adjusting for patient and hospital characteristics.
The cohort was 266,210 patients, comprised of White (84%), Black (6%) and Hispanic (10%) individuals. Median opioid dosage was 20 MME and 55.5% received ketorolac. Our adjusted model showed Whites had highest median MME (20 mg) with Blacks (-3.3 mg [95% CI: -4.6 mg to -2.1 mg]) and Hispanics (-6.0 mg [95% CI: -6.9 mg to -5.1 mg]) receiving less. Blacks were less likely to receive ketorolac (OR: 0.72, 95% CI: 0.62-0.84) while there was no difference between Whites and Hispanics.
Black and Hispanic patients in American Emergency Departments with acute renal colic receive less opioid medication than White patients; Black patients are also less likely to receive ketorolac.
我们旨在量化在美国急诊部因肾绞痛就诊的患者在使用镇痛剂方面的种族差异。
我们从 2003 年至 2015 年的全国代表性 Premier 医院数据库中确定了所有因尿路结石到急诊部就诊的患者。我们纳入了在 1 天内出院的患者，并排除了患有慢性疼痛或肾功能不全的患者。我们通过多变量回归模型评估了种族/民族与阿片类药物剂量（以吗啡毫克当量（MME）和酮咯酸表示）之间的关系，同时调整了患者和医院的特征。
队列由 266210 名患者组成，包括白人（84%）、黑人（6%）和西班牙裔（10%）。中位数阿片类药物剂量为 20MME，55.5%的患者接受了酮咯酸治疗。我们的调整模型显示，白人的中位数 MME 最高（20mg），而黑人（-3.3mg[95%CI：-4.6mg 至 -2.1mg]）和西班牙裔（-6.0mg[95%CI：-6.9mg 至 -5.1mg]）的接受量较少。黑人接受酮咯酸的可能性较低（OR：0.72，95%CI：0.62-0.84），而白人和西班牙裔之间则没有差异。
在美国急诊部因急性肾绞痛就诊的黑人和西班牙裔患者比白人患者接受的阿片类药物剂量较少；黑人患者也较少接受酮咯酸治疗。
