Prehospital pain medication disparities among pediatric trauma patients transported to a single Level I center.

Abstract

Background: This study examines the association of race and ethnicity with prehospital pain medication use among pediatric trauma patients transported to a single Level I trauma center. Results augment existing literature by highlighting intersecting social and demographic factors while adjusting for clinical need and appropriateness.

Methods: A retrospective cohort study was conducted of all patients transported directly to our hospital from the scene of injury from August 2015 through July 2022. We examined multiple outcomes including whether prehospital pain medication was administered, what medication, routes, and doses were used, and trends over time. Multivariable modified mixed effects Poisson regression with robust error variance was used to estimate relative rates of pain medication use.

Results: Among 2,308 pediatric trauma patients, 82% had any prehospital record of pain and 67% had a pain score of at least 4 out of 10, yet 35% received pain medication. Black or Hispanic patients were 20% to 23% less likely to receive prehospital pain medication than White patients (adjusted relative rate, 0.77; 95% confidence interval, 0.71-0.84 and adjusted relative rate, 0.80; 95% confidence interval, 0.74-0.87, respectively) after controlling for clinical need, appropriateness, and patient or family preference. Factors associated with both race/ethnicity and not receiving pain medication included younger age, lower socioeconomic status, language barrier, lack of prehospital vascular access, and involvement in a motor vehicle collision. Improvement was seen over the study period: the proportion of trauma patients given prehospital pain medication increased and disparities by race and ethnicity decreased in magnitude.

Conclusion: Prehospital treatment of pain was suboptimal among pediatric trauma patients and unequal by race and ethnicity. Understanding of local factors that may drive these disparities provide avenues to drive change from multiple angles. Potential prehospital care interventions could target implicit biases, diversity in hiring, training in treatment of pain in young children, and possibly expansion of intranasal and oral medication use.

Level of evidence: Observational (Retrospective Cohort); Level III.