Association of race and ethnicity with management of abdominal pain in the emergency department.
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.
Children's Hospital of Philadelphia, Division of Pediatric Emergency Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA 19104. johnsont6@email.chop.edu.
Tiffani J
TJ
Johnson
Matthew D
MD
Weaver
Sonya
S
Borrero
Esa M
EM
Davis
Larissa
L
Myaskovsky
Noel S
NS
Zuckerbraun
Kevin L
KL
Kraemer
D015746:Abdominal Pain / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D044469:Racial Groups / Q000208:ethnology*; D055815:Young Adult
abdominal pain; disparities; emergency department; racial difference