O1021: Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported via EMS

Background: Pain management remains suboptimal across the continuum of emergency care in both the prehospital and the emergency department (ED) settings. This is amplified in minority populations. Racial and ethnic disparities in the timing of analgesia administration among children who are transported to EDs via emergency medical services (EMS) have not yet been well characterized. The objective of this study is to investigate whether racial and ethnic differences exist in pain management among injured children transported by EMS to pediatric EDs.

Methods: We conducted a secondary analysis of a multicenter prospective observational study of children ages 0 to 17 years transported via EMS to 10 pediatric EDs from July 2019 to April 2020. Timing of ED analgesia (minutes from ED arrival to administration) for patients presenting with an injury were analyzed by race and ethnicity. Race and/or ethnicity were categorized as non-Hispanic White (NH-White), non-Hispanic Black (NH-Black), Hispanic, and Other Race/Multiracial. ED analgesia included opioids, non-opioids, nonsteroidal anti-inflammatory drugs, and other analgesic medications by all routes of administration and were stratified by type.

Results: Among 480 injured children, 353 (74%) received pain medication in the ED after EMS transport (Table 1). Although most patients received pain medication while in the ED, the time to pain management varied greatly (median time 39 minutes; range 2 minutes to 6 hours). The median time to pain medication in the ED was longer for Hispanic patients (55 minutes vs. 38 minutes for NH-Black, 37 minutes for NH-White, and 32 minutes for Other Race/Multiracial children, p=0.015). The median time to ED opioid administration for all groups was 28 minutes (range 2 minutes to 3 hours). Approximately 30% of NH-Black patients, 26% of Hispanic patients, and 14% of Other Race/Multiracial children were treated with opioids in the ED, while 38% of NH-White patients were treated with opioids (p=0.0234). Patients who had broken long bones, had a higher pain score upon arrival to ED, and those who received opioids with EMS were more likely to receive ED opioids. Both the cumulative analgesia and opioid administration across racial and ethnic groups over time in the ED is shown (Figure 1).

Conclusion: Among children transported by EMS to a pediatric ED for an injury, Hispanic patients were less likely to receive timely analgesic medication and were less likely to receive opioids at all. Differences exist in the timing of analgesia administration in the ED by ethnicity. Those of Other Race/Multiracial groups were less likely to receive analgesia but when received was at the quickest rate. In order to improve health equity in pediatric emergency care, further research is needed to understand and mitigate potential root causes of these disparities.