Association of race and ethnicity with management of abdominal pain in the emergency department

Abstract

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Methods: Secondary analysis of data from the 2006-2009 National Hospital Ambulatory Medical Care Survey regarding 2298 visits by patients ≤ 21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as ≥ 7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission.

Results: Of patient visits, 70.1% were female, 52.6% were from non-Hispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from "other" racial/ethnic groups; patients' mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.43-0.87) or a narcotic analgesic (OR: 0.38; 95% CI: 0.18-0.81) than non-Hispanic white patients (referent group). This finding was also true for non-Hispanic black and "other" race/ethnicity patients with severe pain (ORs [95% CI]: 0.43 [0.22-0.87] and 0.02 [0.00-0.19], respectively). Non-Hispanic black and Hispanic patients were more likely to have a prolonged LOS than non-Hispanic white patients (ORs [95% CI]: 1.68 [1.13-2.51] and 1.64 [1.09-2.47], respectively). No significant race/ethnicity-based disparities were identified in documentation of pain score, use of diagnostic procedures, 72-hour return visits, or hospital admissions.

Conclusions: Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care.

Keywords: abdominal pain; disparities; emergency department; racial difference.

FIGURE 1

Management of pain in children who presented with abdominal pain to EDs. Findings are from multivariate logistic regression models that adjusted for confounders (age, gender, pain level, triage level, type of hospital ownership, geographic region, income, and insurance status) and used non-Hispanic white patients as the referent group. Severe pain was defined as a score of ≥7 on a 10-point scale. Values that do not cross 1 (dotted line) were considered statistically significant.

FIGURE 2

Diagnostic tests ordered for children who presented with abdominal pain to EDs. Findings are from multivariate logistic regression models that adjusted for confounders (age, gender, pain level, triage level, type of hospital ownership, geographic region, income, and insurance status) and used non-Hispanic white patients as the referent group. Values that do not cross 1 (dotted line) were considered statistically significant.

FIGURE 3

Hospital-related processes for children who presented with abdominal pain to EDs. Findings are from multivariate logistic regression models that adjusted for confounders (age, gender, pain level, triage level, type of hospital ownership, geographic region, income, and insurance status) and used non-Hispanic white patients as the referent group. Prolonged LOS was defined as >6 hours, and return visit defined as return within 72 hours. Values that do not cross 1 (dotted line) were considered statistically significant.