From the Dell Medical School at the University of Texas at Austin, Austin, TX.
J Am Coll Surg. 2023 Mar 1;236(3):461-467. doi: 10.1097/XCS.0000000000000486. Epub 2022 Nov 21.
Although evidence suggests that racial and ethnic minority (REM) patients receive inadequate pain management in the acute care setting, it remains unclear whether these disparities also occur during the prehospital period. The aim of this study is to assess the impact of race and ethnicity on prehospital analgesic use by emergency medical services (EMS) in trauma patients.
Retrospective chart review of adult trauma patients aged 18 to 89 years old transported by EMS to our American College of Surgeons-verified level 1 trauma center from 2014 to 2020. Patients who identified as Black, Asian, Native American, or Other for race and/or Hispanic or Latino or Unknown for ethnicity were considered REM. Patients who identified as White, non-Hispanic were considered White. Groups were compared in univariate and multivariate analysis. The primary outcome was prehospital analgesic administration.
A total of 2,476 patients were transported by EMS (47% White and 53% REM). White patients were older on average (46 years vs 38 years; p < 0.001) and had higher rates of blunt trauma (76% vs 60%; p < 0.001). There were no differences in Injury Severity Score (21 vs 20; p = 0.22). Although REM patients reported higher subjective pain rating (7.2 vs 6.6; p = 0.002), they were less likely to get prehospital pain medication (24% vs 35%; p < 0.001), and that difference remained significant after controlling for baseline characteristics, transport method, pain rating, prehospital hypotension, and payor status (adjusted odds ratio [95% CI], 0.67 [0.47 to 0.96]; p = 0.03).
Patients from racial and ethnic minority groups were less likely to receive prehospital pain medication after traumatic injury than White patients. Forms of conscious and unconscious bias contributing to this inequity need to be identified and addressed.
尽管有证据表明，在急性护理环境中，少数民族和种族少数群体（REM）患者的疼痛管理不足，但在院前阶段是否也存在这些差异仍不清楚。本研究旨在评估种族和民族对创伤患者的急诊医疗服务（EMS）院前镇痛使用的影响。
回顾性分析 2014 年至 2020 年间，通过 EMS 转运至我们的美国外科医师学院认证的一级创伤中心的年龄在 18 至 89 岁的成年创伤患者的图表。将自我报告为黑种人、亚裔、美国原住民或其他种族，以及西班牙裔或拉丁裔或未知种族的患者视为 REM。将自我报告为白种人、非西班牙裔的患者视为白种人。在单变量和多变量分析中对两组进行比较。主要结局是院前镇痛管理。
共有 2476 名患者通过 EMS 转运（47%为白种人，53%为 REM）。白种人患者的平均年龄较大（46 岁比 38 岁；p < 0.001），钝性创伤发生率较高（76%比 60%；p < 0.001）。损伤严重程度评分无差异（21 分比 20 分；p = 0.22）。尽管 REM 患者报告的主观疼痛评分较高（7.2 分比 6.6 分；p = 0.002），但他们接受院前止痛药物的可能性较小（24%比 35%；p < 0.001），而且在控制基线特征、转运方式、疼痛评分、院前低血压和付款人状态后，这种差异仍然显著（调整后的优势比[95%置信区间]，0.67[0.47 至 0.96]；p = 0.03）。
与白人患者相比，创伤后接受院前疼痛药物治疗的少数民族和种族少数群体患者比例较低。需要确定并解决导致这种不平等的有意识和无意识偏见的形式。
