Women are less likely than men to receive prehospital analgesia for isolated extremity injuries.
OBJECTIVE
The goal of this study was to examine the effect of socioeconomic factors, such as ethnicity, income, age, and sex, on the administration of analgesia for isolated extremity injuries in the prehospital setting.


METHODS
For this retrospective study, the electronic medical record of a large ground-based emergency medical services agency was reviewed and all isolated extremity injuries occurring during the year 2005 were extracted. A total of 1009 cases met the inclusion criteria. Of these cases, 56 were excluded because of incomplete records, leaving 953 cases for analysis. Basic univariate analysis as well as logistic regression analysis were used to examine the relationship between analgesia administration and patient age, ethnicity, sex, income, subjective pain severity, and time under prehospital care.


RESULTS
A total of 279 patients (29%) received morphine. Both univariate and logistic regression analysis revealed significant differences in analgesia administration based on sex (proportion of men receiving analgesia, 32.8%; women, 26.7%), initial pain severity, and time under prehospital care. Although no category of income was itself significant, a significant trend emerged in which increasing income was associated with increasing likelihood of receiving analgesia. There was no significant difference in analgesia based on patient age or ethnicity.


CONCLUSIONS
This study suggests that women are less likely than men to receive prehospital analgesia for isolated extremity injuries. Patients with higher pain severity and longer duration of prehospital care are more likely to receive prehospital analgesia. Increasing levels of income were associated with increased rates of analgesia. The overall rate of prehospital analgesia administration for isolated extremity injuries in this population is higher than has been reported for other emergency medical services systems (29% vs 2%-18% in other recent studies), but there remains considerable room for improvement in the provision of prehospital analgesia. Further inquiry is needed to determine why certain populations such as women receive disproportionately less analgesia.
Michael
Glen E
GE
School of Medicine, University of California, San Francisco, CA 94143, USA. glen.michael@ucsf.edu
Sporer
Karl A
KA
Youngblood
Glen M
GM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D001134:Arm Injuries / Q000150:complications*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors
D000701:Analgesics, Opioid; D009020:Morphine