title: Racial differences in receiving morphine among prehospital patients with blunt trauma.
abstract: BACKGROUND
  Pain management is an important part of prehospital care, yet few studies have addressed the effects of age, sex, race, or pain severity on prehospital pain management.
  
  
  OBJECTIVE
  To examine the association of sex, age, race, and pain severity with analgesia administration for blunt trauma in the prehospital setting.
  
  
  METHODS
  In this retrospective cohort study, we used the automated registry of a large urban Emergency Medical Services agency to identify records of all patients transported for blunt trauma injuries between February 1 and November 1, 2009. We used bivariable and multivariable analyses with logistic regression models to determine the relationship between analgesia administration and patient sex, race, age, pain score on a pain scale, and time under prehospital care.
  
  
  RESULTS
  We identified 6398 blunt trauma cases. There were 516 patients (8%) who received analgesia overall; among patients for whom a pain scale was recorded, 25% received analgesia. By multivariable analysis, adjusting for race, sex, age, time with patient, and pain score, African-American and Hispanic patients were less likely than Caucasian patients to receive analgesia. Pain score and prehospital time were both significant predictors of analgesia administration, with higher pain score and longer prehospital time associated with increased administration of pain medication. Neither sex nor age was a significant predictor of analgesia administration in the regression analysis.
  
  
  CONCLUSIONS
  This study suggests that Caucasians are more likely than African-Americans or Hispanics to receive prehospital analgesia for blunt trauma injuries. In addition, patients with whom paramedics spend more time and for whom a pain score is recorded are more likely to receive analgesia.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center - Highland Campus, Oakland, California 94602, USA.
authors.forename: Megann F
authors.initials: MF
authors.lastname: Young
authors.forename: H Gene
authors.initials: HG
authors.lastname: Hern
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Alter
authors.forename: Joseph
authors.initials: J
authors.lastname: Barger
authors.forename: Farnaz
authors.initials: F
authors.lastname: Vahidnia
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004632:Emergency Medical Services; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000208:ethnology* / Q000209:etiology; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D019037:Urban Health Services; D044465:White People / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000150:complications; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine