Racial disparities related to the administration of analgesia to treat pain for pediatric appendicitis exist, and black children are less likely to receive pain medication than white children, according to a study recently published in JAMA Pediatrics.
Researchers conducted a repeated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey from 2003 to 2010, covering more than 900,000 children with acute appendicitis.
Overall, the rate of administration to children diagnosed with appendicitis was low; roughly 57 percent of those sampled received analgesia of any kind, and 41.3 percent received opioid analgesia.
In a multivariable model, there were no significant differences in the overall rate of analgesia administration by race. However, when stratified by pain score and adjusted for ethnicity, researchers found black patients with moderate pain were less likely to receive any analgesia than white patients with moderate pain. Among those with severe pain, black patients received opioid analgesia significantly less frequently than white patients (12.2 percent and 33.9 percent, respectively).
According to the report, these findings are consistent with other studies that have shown low rates of administration of analgesia to patients with appendicitis. Low rates could be due to the belief commonly shared by clinicians that analgesia may lead to diagnostic delays by masking the disease, despite that several randomized trials have demonstrated the use of opioid analgesia to manage acute abdominal pain is safe and doesn't negatively impact diagnosis or treatment.
Regardless, this perception would not explain the racial disparities observed in the current study.
"The racial disparities we identified with respect to opioid administration were striking. It was surprising that although there were no differences in overall analgesia administration by race, black patients were much less likely to receive opioid analgesia than white patients even after adjustment for potential confounders, including pain score," the authors of the study wrote. "Our findings suggest that although clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating black patients with nonopioid analgesia, such as ibuprofen and acetaminophen, while treating white patients with opioid analgesia for similar pain."
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