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Pavlova A, Paine SJ, Cavadino A, O'Callaghan A, Consedine NS. Do I care for you more when you really need help? An experimental test of the effect of clinical urgency on compassion in health care. Br J Health Psychol 2024; 29:59-79. [PMID: 37648902 DOI: 10.1111/bjhp.12687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking to address systemic barriers to compassion in health care. DESIGN This is a pre-registered online study with an experimental, within-subjects repeated-measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion. METHODS Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired-sample t-tests were used to test the effect of the presentation urgency on indices of compassion. RESULTS A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient. CONCLUSIONS This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system-wide orientation towards efficiency and urgency may exacerbate this 'bias' which must be addressed to ensure more equitable compassion in health care.
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Affiliation(s)
- Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Poupore NS, Jeong SS, Fields CM, Nguyen SA, Carroll WW. Pediatric obesity education and counseling in otolaryngology clinics: A survey of ASPO members. Int J Pediatr Otorhinolaryngol 2023; 175:111456. [PMID: 37169659 DOI: 10.1016/j.ijporl.2023.111456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Adenotonsillectomy can cure pediatric obstructive sleep apnea (OSA) in 80% of children without obesity but only 20-30% of children with obesity. Despite this, there is a current lack of consistent guidelines and practices around pediatric obesity management in otolaryngology. This study evaluated the extent of counseling, referrals, confidence, and barriers in addressing childhood obesity in pediatric otolaryngology. METHODS A 20-question electronic survey assessing pediatric obesity practice patterns regarding sleep-disordered breathing (SDB) and OSA was distributed to all American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics were performed. Pediatric otolaryngologists were compared using logistic regression models based on their practice type and frequency of counseling and referral. RESULTS Of all ASPO members, 19.6% (114/583) completed the survey. Half (50.0%) of physicians counsel and 14.0% refer to obesity management >75% of the time. Only 8.8% of physicians are confident their counseling helps reduce their patient's obesity, and 35.9% of physicians are satisfied with their services available for referral. Most physicians cite time/clinical workload (81.6%) and parent/rearing habits (50.0%) as barriers to obesity counseling. Non-academic physicians had lower odds of counseling and referring their patients >50% of the time (aOR 0.23 [95%CI 0.06-0.81], aOR 0.23 [95%CI 0.06-0.83]). Almost all (92.1%) physicians counsel on residual SDB or OSA after adenotonsillectomy >75% of the time if the child is obese. CONCLUSIONS Most pediatric otolaryngologists do not regularly counsel or refer patients to available obesity management programs, with differences seen between academic and non-academic surgeons. Confidence is low in currently available measures to reduce pediatric obesity. These results highlight the challenges of pediatric obesity and provide context for guideline implementation and additional resource development for pediatric otolaryngologists.
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Affiliation(s)
- Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Routledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Seth S Jeong
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Routledge Avenue, MSC550, Charleston, SC, 29425, USA; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Caroline M Fields
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Routledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Routledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Routledge Avenue, MSC550, Charleston, SC, 29425, USA
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Beni CE, Rice-Townsend SE, Esangbedo ID, Jancelewicz T, Vogel AM, Newton C, Boomer L, Rothstein DH. Outcome of Extracorporeal Cardiopulmonary Resuscitation in Pediatric Patients Without Congenital Cardiac Disease: Extracorporeal Life Support Organization Registry Study. Pediatr Crit Care Med 2023; 24:927-936. [PMID: 37477526 DOI: 10.1097/pcc.0000000000003322] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVES To describe the use of extracorporeal cardiopulmonary resuscitation (ECPR) in pediatric patients without congenital heart disease (CHD) and identify associations with in-hospital mortality, with a specific focus on initial arrest rhythm. DESIGN Retrospective cohort study using data from pediatric patients enrolled in Extracorporeal Life Support Organization (ELSO) registry between January 1, 2017, and December 31, 2019. SETTING International, multicenter. PATIENTS We included ECPR patients under 18 years old, and excluded those with CHD. Subgroup analysis of patients with initial arrest rhythm. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified 567 patients: neonates (12%), infants (27%), children between 1 and 5 years old (25%), and children over 5 years old (36%). The patient cohort included 51% males, 43% of White race, and 89% not obese. Most suffered respiratory disease (26%), followed by acquired cardiac disease (25%) and sepsis (12%). In-hospital mortality was 59%. We found that obesity (adjusted odds ratio [aOR], 2.28; 95% CI, 1.21-4.31) and traumatic injury (aOR, 6.94; 95% CI, 1.55-30.88) were associated with greater odds of in-hospital mortality. We also identified lower odds of death associated with White race (aOR, 0.64; 95% CI, 0.45-0.91), ventricular tachycardia (VT) as an initial arrest rhythm (aOR, 0.36; 95% CI, 0.16-0.78), return of spontaneous circulation before cannulation (aOR, 0.56; 95% CI, 0.35-0.9), and acquired cardiac disease (aOR, 0.43; 95% CI, 0.29-0.64). Respiratory disease was associated with greater odds of severe neurologic complications (aOR, 1.64; 95% CI, 1.06-2.54). CONCLUSIONS In children without CHD undergoing ECPR, we found greater odds of in-hospital mortality were associated with either obesity or trauma. The ELSO dataset also showed that other variables were associated with lesser odds of mortality, including VT as an initial arrest rhythm. Prospective studies are needed to elucidate the reasons for these survival differences.
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Affiliation(s)
| | | | - Ivie D Esangbedo
- Department of Pediatrics, Section of Cardiac Critical Care, University of Washington, Seattle, WA
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Adam M Vogel
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Christopher Newton
- Department of Surgery, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA
| | - Laura Boomer
- Department of Surgery, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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Davis J, Sanchez LD, Jarman AF, Macias-Konstantopoulos W, Newberry J, Patel S, Hess E, Burner E. 2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research. Acad Emerg Med 2023; 30:731-741. [PMID: 37078910 PMCID: PMC10467350 DOI: 10.1111/acem.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023]
Abstract
Racism in emergency medicine (EM) health care research is pervasive but often underrecognized. To understand the current state of research on racism in EM health care research, we developed a consensus working group on this topic, which concluded a year of work with a consensus-building session as part of the overall Society for Academic Emergency Medicine (SAEM) consensus conference on diversity, equity, and inclusion: "Developing a Research Agenda for Addressing Racism in Emergency Medicine," held on May 10, 2022. In this article, we report the development, details of preconference methods and preliminary results, and the final consensus of the Healthcare Research Working Group. Preconference work based on literature review and expert opinion identified 13 potential priority research questions that were refined through an iterative process to a list of 10. During the conference, the subgroup used consensus methodology and a "consensus dollar" (contingent valuation) approach to prioritize research questions. The subgroup identified three research gaps: remedies for racial bias and systematic racism, biases and heuristics in clinical care, and racism in study design, and we derived a list of six high-priority research questions for our specialty.
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Affiliation(s)
- Joshua Davis
- University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women’s Faulkner Hospital, Boston, Massachusetts, USA
| | - Angela F Jarman
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | | | - Jennifer Newberry
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Shama Patel
- Department of Emergency Medicine University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Erik Hess
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Kek School of Medicine of the University of Southern California, Los Angeles, California, USA
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Marini M, Casile A. I can see my virtual body in a mirror: The role of visual perspective in changing implicit racial attitudes using virtual reality. Front Psychol 2022; 13:989582. [PMID: 36518959 PMCID: PMC9742480 DOI: 10.3389/fpsyg.2022.989582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/04/2022] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Recent studies showed that VR is a valid tool to change implicit attitudes toward outgroup members. Here, we extended this work by investigating conditions under which virtual reality (VR) is effective in changing implicit racial attitudes. METHODS To this end, participants were embodied in a Black or White avatar and we manipulated the perspective through which they could see their virtual body. Participants in one condition, could see their virtual body both from a first-person perspective (i.e., by looking down toward themselves) and reflected in a mirror placed in front of them in the VR environment. Participants in another condition could instead see their virtual body only from a first-person perspective (i.e., by looking down toward themselves) as no mirror was placed in the VR environment. Implicit racial attitudes were assessed using the Implicit Association Test (IAT) before and immediately after the VR intervention. RESULTS Results showed that when White participants were embodied in a Black avatar compared to a White avatar, they showed a decrease in their implicit pro-White attitudes but only when they could see their virtual body both from a first-person perspective and in a mirror. DISCUSSION These results suggest that, in immersive virtual reality interventions, the possibility for participants to see their body also reflected in a mirror, might be a critical factor in changing their implicit racial attitudes.
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Affiliation(s)
- Maddalena Marini
- Center for Translational Neurophysiology of Speech and Communication, Istituto Italiano di Tecnologia, Ferrara, Italy
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Antonino Casile
- Center for Translational Neurophysiology of Speech and Communication, Istituto Italiano di Tecnologia, Ferrara, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
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Hagiwara N, Duffy C, Quillin J. Implicit and explicit racial prejudice and stereotyping toward Black (vs. White) Americans: The prevalence and variation among genetic counselors in North America. J Genet Couns 2022; 32:397-410. [PMID: 36341692 PMCID: PMC10168592 DOI: 10.1002/jgc4.1648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
Research has shown that patient experiences and outcomes of genetic counseling are not equitable across racial categories, disadvantaging Black patients relative to White patients. One major factor contributing to such racial disparities might be genetic counselor racial bias. The present study examined the prevalence of and variation in racial bias toward Black (vs. White) Americans among genetic counselors in North America. This study extends the current literature of racial disparities in experiences and outcomes of genetic counseling by distinguishing prejudice (negative feelings or attitudes) and stereotyping (beliefs) at the implicit and explicit levels as well as by including both certified genetic counselors and genetic counseling trainees. Two-hundred and fifteen genetic counselors (107 genetic counselors Board-certified by the American Board of Genetic Counseling, 108 genetic counseling trainees from Accreditation Council for Genetic Counseling accredited programs) completed four measures in a random order: the Race Implicit Association Test (IAT, for implicit prejudice), feeling thermometer (for explicit prejudice), the Medical Cooperativeness IAT (for implicit stereotyping), and a self-report measure of explicit stereotypes (for explicit stereotyping). On average, genetic counselors (both certified genetic counselors and genetic counseling trainees) were slightly to moderately in favor of White Americans over Black Americans at the implicit level. They were also slightly more likely to associate "medically cooperative" stereotypes with White Americans more than Black Americans implicitly. In contrast, genetic counselors, on average, did not display either explicit prejudice or explicit negative stereotyping, which may reflect social desirability concerns among genetic counselors. However, genetic counselors as a group strongly endorsed stereotypes related to mistrust (mistrustful of the healthcare system, skeptical of genetic testing, mistrustful of genetic counselors) to be more true for Black (vs. White) Americans. Finally, our study revealed relatively large variability in each type of bias across genetic counselors. Future research should examine how such variability in each type of bias is associated with patient experiences and outcomes of genetic counseling.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology Virginia Commonwealth University Richmond Virginia USA
| | - Conor Duffy
- Department of Psychology Virginia Commonwealth University Richmond Virginia USA
| | - John Quillin
- Department of Pediatrics Virginia Commonwealth University School of Medicine Richmond Virginia USA
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Buchanan R, Roy N, Parra MF, Staffa SJ, Brown ML, Nasr VG. Race and Outcomes in Patients with Congenital Cardiac Disease in an Enhanced Recovery Program. J Cardiothorac Vasc Anesth 2022; 36:3603-3609. [PMID: 35577651 DOI: 10.1053/j.jvca.2022.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Disparities in perioperative outcomes exist. In addition to patient and socioeconomic factors, racial disparities in outcome measures may be related to issues at the provider and institutional levels. Recognizing a potential role of standardized care in mitigating provider bias, this study aims to compare the perioperative sedation and pain management and consequent outcomes in Enhanced Recovery After Surgery (ERAS) cardiac patients of different races undergoing congenital heart surgery at a single quaternary children's hospital. DESIGN A retrospective study. SETTING A single quaternary pediatric hospital. PARTICIPANTS Patients, infants to adults, undergoing elective congenital cardiac surgery and enrolled in the ERAS protocol from October 2018 to December 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the patients, 872 were reviewed and 606 with race information were analyzed. There was no significant difference in intraoperative and postoperative oral morphine equivalent, perioperative sedatives, and regional blockade in Asian or African American patients when compared to White patients. Postoperative pain scores and outcomes among African American and Asian races were also not statistically different when compared to White patients. CONCLUSIONS Racial disparity in perioperative management and outcomes in patients with standardized ERAS protocols does not exist at the authors' institution. Future comparative studies of ERAS noncardiac patients may provide additional information on the role of standardization in reducing implicit bias.
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Affiliation(s)
- Rica Buchanan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Nathalie Roy
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - M Fernanda Parra
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States.
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Gutman CK, Holmes S, Balhara KS. Low-value care in pediatric populations: There is no silver lining. Acad Emerg Med 2022; 29:804-807. [PMID: 35212441 DOI: 10.1111/acem.14470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Colleen K. Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - Sherita Holmes
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
- Division of Emergency Medicine Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
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Guedj R, Marini M, Kossowsky J, Berde CB, Kimia AA, Fleegler EW. Racial and Ethnic Disparities in Pain Management of Children With Limb Fractures or Suspected Appendicitis: A Retrospective Cross-Sectional Study. Front Pediatr 2021; 9:652854. [PMID: 34414139 PMCID: PMC8369476 DOI: 10.3389/fped.2021.652854] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate whether racial/ethnical differences in analgesia administration existed in two different cohorts of children with painful conditions: children with either limb fracture or suspected appendicitis. Methods: Retrospective cross-sectional analysis of children visiting a pediatric emergency department (Boston Children Hospital) for limb fracture or suspected appendicitis from 2011 to 2015. We computed the proportion of children that received any analgesic treatment and any opioid analgesia. We performed multivariable logistic regressions to investigate race/ethnicity differences in analgesic and opioid administration, after adjusting for pain score, demographics and visit covariates. Results: Among the 8,347 children with a limb fracture and the 4,780 with suspected appendicitis, 65.0 and 60.9% received any analgesic treatment, and 35.9 and 33.4% an opioid analgesia, respectively. Compared to White non-Hispanic Children, Black non-Hispanic children and Hispanic children were less likely to receive opioid analgesia in both the limb fracture cohort [Black: aOR = 0.61 (95% CI, 0.50-0.75); Hispanic aOR = 0.66 (95% CI, 0.55-0.80)] and in the suspected appendicitis cohort [Black: aOR = 0.75 (95% CI, 0.58-0.96); Hispanic aOR = 0.78 (95% CI, 0.63-0.96)]. In the limb fracture cohort, Black non-Hispanic children and Hispanic children were more likely to receive any analgesic treatment (non-opioid or opioid) than White non-Hispanic children [Black: aOR = 1.63 (95% CI, 1.33-2.01); Hispanic aOR = 1.43 (95% CI, 1.19-1.72)]. Conclusion: Racial and ethnic disparities exist in the pain management of two different painful conditions, which suggests true inequities in health care delivery. To provide equitable analgesic care, emergency departments should monitor variation in analgesic management and develop appropriate universal interventions.
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Affiliation(s)
- Romain Guedj
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatric Emergency Medicine, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, Paris, France.,Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, Paris, France
| | - Maddalena Marini
- Istituto Italiano di Tecnologia, Center for Translational Neurophysiology, Ferrara, Italy
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Amir A Kimia
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States
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