Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain.
OBJECTIVE
Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain.


METHODS
This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used.


RESULTS
Of the 981 patients enrolled (mean age +/- standard deviation [SD] 41 +/- 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes).


CONCLUSIONS
Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy.
Chen
Esther H
EH
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. esther.chen@uphs.upenn.edu
Shofer
Frances S
FS
Dean
Anthony J
AJ
Hollander
Judd E
JE
Baxt
William G
WG
Robey
Jennifer L
JL
Sease
Keara L
KL
Mills
Angela M
AM
D015746:Abdominal Pain / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000698:Analgesia; D015415:Biomarkers; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D015415:Biomarkers