Dixit Anjali A, Elser Holly, Chen Catherine L, Ferschl Marla, Manuel Solmaz P
Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA.
School of Medicine, Stanford University, Stanford, CA 94309, USA.
Children (Basel). 2020 Oct 4;7(10):163. doi: 10.3390/children7100163.
Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient's recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22-4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67-3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79-4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48-7.06). In summary, English language proficiency may affect the management of children's pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.
种族和族裔与儿童疼痛管理方面的差异有关。在美国，英语水平低与少数族裔相关，但在健康差异研究中对此探讨较少。因此，我们调查了在旧金山一家儿科医院接受腹腔镜阑尾切除术的儿童队列中，英语水平是否会影响术后麻醉护理单元（PACU）的疼痛管理。我们的主要暴露因素是英语水平，主要结局是在PACU中使用任何阿片类药物。次要结局包括在PACU中使用的阿片类药物剂量以及患者恢复期是否记录了任何疼痛评分。统计分析包括在估计语言水平对这些结局的影响时对包括种族在内的人口统计学协变量进行调整。在我们的257名儿科患者队列中，57名（22.2%）英语水平低（LEP）。虽然LEP患者和英语熟练（EP）患者术中接受的阿片类药物剂量相同，但在多变量分析中，LEP患者在PACU中接受任何阿片类药物的几率是EP患者的两倍多（OR 2.45，95% CI 1.22 - 4.92）。LEP患者比EP患者接受更多的口服吗啡等效物（OME）（1.64 OME/kg，CI 0.67 - 3.84），并且在PACU恢复期没有记录疼痛评分的几率几乎是EP患者的两倍（OR 1.93，CI 0.79 - 4.73），尽管这些估计的精确性因样本量小而受限。亚组分析表明，5岁以上的儿童可能语言表达能力更强，因此会接受语言疼痛评估，其没有记录疼痛评分的几率是其他儿童的三倍多（OR 3.23，CI 为1.48 - 7.06）。总之，英语水平可能会影响围手术期儿童疼痛的管理。这种与语言相关的差异的病因可能是多因素的，应进一步研究。
