title: A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care.
abstract: BACKGROUND
  Previous studies examining sex-based disparities in emergency department (ED) pain care have been limited to a single pain condition, a single study site, and lack rigorous control for confounders.
  
  
  OBJECTIVE
  A multicenter evaluation of the effect of sex on abdominal pain (AP) and fracture pain (FP) care outcomes.
  
  
  METHODS
  A retrospective cohort review of ED visits at 5 US hospitals in January, April, July, and October 2009.
  
  
  METHODS
  A total of 6931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249) were included.
  
  
  METHODS
  The primary predictor was sex. The primary outcome was time to analgesic administration. Secondary outcomes included time to medication order, and the likelihood of receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain score, ED crowding, and triage acuity.
  
  
  RESULTS
  On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP women: 112 (65-187) minutes, men: 96 (52-167) minutes, P<0.001] and ordering [women: 84 (41-160) minutes, men: 71 (32-137) minutes, P<0.001], whereas women with FP did not (Administration: P=0.360; Order: P=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR=0.766; 95% CI, 0.670-0.875; P<0.001), whereas women with FP were not (P=0.357).
  
  
  CONCLUSIONS
  In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease sex disparities in pain care should take type of pain into account.
authors.affiliation: *Emergency Department, Icahn School of Medicine at Mount Sinai, New York, NY †Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC ‡Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA §Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO ∥Mount Sinai Beth Israel, New York, NY.
authors.forename: Ammar
authors.initials: A
authors.lastname: Siddiqui
authors.forename: Laura
authors.initials: L
authors.lastname: Belland
authors.forename: Laura
authors.initials: L
authors.lastname: Rivera-Reyes
authors.forename: Daniel
authors.initials: D
authors.lastname: Handel
authors.forename: Kabir
authors.initials: K
authors.lastname: Yadav
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
authors.forename: Amanda
authors.initials: A
authors.lastname: Eisenberg
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000453:epidemiology*; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution
chemical_list: D000700:Analgesics