Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population.
OBJECTIVE
We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation.


METHODS
A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol.


RESULTS
During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval -0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval -16% to 18%).


CONCLUSIONS
Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED.
Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. Electronic address: i_shavit@rambam.health.gov.il.
Itai
I
Shavit
Pediatric Department B, Rambam Health Care Campus, Haifa, Israel.
Eliaz
E
Brumer
Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
Danielle
D
Shavit
Pediatric Orthopedic Unit, Rambam Health Care Campus, Haifa, Israel.
Mark
M
Eidelman
Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Ivan P
IP
Steiner
Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
Carmit
C
Steinberg
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D018912:Arabs / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000208:ethnology*; D006801:Humans; D007557:Israel; D007585:Jews / Q000706:statistics & numerical data; D004204:Joint Dislocations / Q000150:complications* / Q000208:ethnology*; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012189:Retrospective Studies
D000701:Analgesics, Opioid