579 - Racial/Ethnic Differences in ED Sedation for Long Bone Fracture Reduction

Racial and ethnic differences in emergency department (ED) pain management among children with long bone fractures have been documented.

Objective:

This study investigated differences in the utilization of procedural sedation and pain treatment for children undergoing fracture reduction.

Design/Methods:

A multi-site registry of electronic health record data of visits to four pediatric EDs (PECARN Registry) was used to perform a retrospective cross-sectional study of children < 19 years who underwent fracture reduction and were discharged between January 1, 2016 and December 31, 2019. The proportion of children undergoing procedural sedation and receipt of any analgesic, or opioid analgesic specifically, were analyzed by patient characteristic and site. Modified Poisson regression was performed to explore differences in treatment practices between racial and ethnic groups. Adjusted risk-ratios (aRR) and 95% confidence intervals (CI) were estimated, adjusting for age, sex, upper vs. lower extremity, initial pain score, insurance status and clinical site.

Results:

Of 34,780 ED visits for long bone fractures, 10,233 (29%) were reduced.  6,694 (65.4%) were male, median age was 9.0 years (IQR: 6.3, 12.1) (Table 1).  Overall the population was 7,032 (68.7%) Non-Hispanic (NH) White, 1,625 (15.9%) NH-Black, 633 (6.2%) Hispanic, and 943 (9.2%) Other (Table 1). 7430 (72.6%) received any analgesic, 5461 (53.4%) received opioid analgesic, and 8,624 (84.3%) were sedated.  Rates of procedural sedation were lower for NH-Black (82.5%) and other race/ethnicities (81.4%) compared to NH-White (84.8%) children. Additionally, adjusted RR [95% CI] for sedation for NH-Black 0.96 [0.93, 0.98] and Other 0.96 [0.93, 0.99]) were lower than NH-White (Table 2).  Compared to NH-White children, NH-Black and Hispanic children received any analgesic prior to sedation at a higher rate (NH-White 61.0%; NH-Black 76.2% aRR [95% CI]: 1.14 [1.10, 1.18]; Hispanic 69.3% aRR [95% CI]: 1.09 [1.03, 1.16]) (Table 2). Rates of opioids analgesics received prior to sedation were not significantly different for NH-Black or Hispanic groups compared to NH-White. A higher percentage of NH-Black patients (7.4% vs. 2.8% overall) were triaged into one of the two lowest triage categories (Table 1).

Conclusion(s):

Among children who underwent fracture reduction, NH-Black children and those of other racial/ethnic groups were less likely to receive procedural sedation.  Focused work is needed to evaluate these differences and mitigate inequities, as well as implicit bias, in procedural sedation and analgesic use.