种族和社会经济地位与非手术治疗的儿科创伤患者疼痛控制时间的关系。

Association of race and socioeconomic status with time to pain control among pediatric trauma patients managed nonoperatively.

机构信息

From the Division of Pediatric General and Thoracic Surgery (S.T., T.J., M.K.), Cincinnati Children's Hospital Medical Center; Department of Surgery (M.K.), University of Cincinnati College of Medicine; and Division of Orthopedic Surgery (K.F., J.R.D.) and Department of Anesthesia (V.C.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

出版信息

J Trauma Acute Care Surg. 2023 Sep 1;95(3):403-410. doi: 10.1097/TA.0000000000003889. Epub 2023 Jan 19.

DOI:10.1097/TA.0000000000003889

PMID:36728110

Abstract

BACKGROUND

Few studies have evaluated racial/ethnic inequities in acute pain control among hospitalized injured children. We hypothesized that there would be inequities in time to pain control based on race/ethnicity and socioeconomic status.

METHODS

We performed a retrospective cohort study of all injured children (7-18 years) admitted to our level 1 trauma center between 2010 and 2019 with initial recorded numerical rating scale (NRS) scores of >3 who were managed nonoperatively. A Cox regression survival analysis was used to evaluate the time to pain control, defined as achieving an NRS score of ≤3.

RESULTS

Our cohort included 1,787 admissions. The median age was 14 years (interquartile range, 10-18), 59.5% were male, 76.6% identified as White, 19.9% as Black, and 2.4% as Hispanic. The median initial NRS score was 7 (interquartile range, 5-9), and the median time to pain control was 4.9 hours (95% confidence interval, 4.6-5.3). Insurance status, as a marker of socioeconomic status, was not associated with time to pain control ( p = 0.29). However, the interaction of race/ethnicity and deprivation index was significant ( p = 0.002). Specifically, the socioeconomic deprivation of a child's home neighborhood was an important predictor for non-White children ( p <0.003) but not for White children ( p = 0.41) and non-White children from higher deprivation neighborhoods experienced greater times to pain control (hazard ratio, 1.55; 95% confidence interval, 1.16-2.07). Being female, older, presenting with higher initial NRS scores, and having history of attention-deficit/hyperactivity disorder were all associated with longer times to pain control. Other injury characteristics and psychiatric history were evaluated but ultimately excluded, as they were not significant.

CONCLUSION

Greater neighborhood socioeconomic deprivation was associated with prolonged time to pain control for non-White children admitted after injury and managed nonoperatively. Further work is needed to understand inequities in pain control for injured patients.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

摘要

背景

鲜有研究评估了住院受伤儿童的急性疼痛控制方面的种族/民族差异。我们假设，基于种族/民族和社会经济地位，在疼痛控制时间上会存在差异。

方法

我们对 2010 年至 2019 年期间在我们的一级创伤中心接受非手术治疗的初始记录数字评分量表（NRS）评分>3 的所有受伤儿童（7-18 岁）进行了回顾性队列研究。采用 Cox 回归生存分析评估疼痛控制的时间，定义为达到 NRS 评分≤3。

结果

我们的队列包括 1787 例入院。中位年龄为 14 岁（四分位间距，10-18），59.5%为男性，76.6%为白人，19.9%为黑人，2.4%为西班牙裔。初始 NRS 评分中位数为 7（四分位间距，5-9），疼痛控制的中位时间为 4.9 小时（95%置信区间，4.6-5.3）。保险状况作为社会经济地位的标志，与疼痛控制时间无关（p=0.29）。然而，种族/民族和剥夺指数的相互作用具有统计学意义（p=0.002）。具体而言，儿童家庭社区的社会经济剥夺程度是影响非白人儿童的重要预测因素（p<0.003），但对白人儿童没有影响（p=0.41），来自社会经济剥夺程度较高社区的非白人儿童经历了更长的疼痛控制时间（危险比，1.55；95%置信区间，1.16-2.07）。女性、年龄较大、初始 NRS 评分较高以及有注意力缺陷/多动障碍病史均与疼痛控制时间延长有关。其他损伤特征和精神病史也进行了评估，但最终被排除，因为它们没有统计学意义。