Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population Itai Shavit, MD*; Eliaz Brumer, MD; Danielle Shavit; Mark Eidelman, MD; Ivan P. Steiner, MD; Carmit Steinberg, MA *Corresponding Author. E-mail: i_shavit@rambam.health.gov.il. Study objective: We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation. Methods: A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol. Results: During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval –0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval –16% to 18%). Conclusion: Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED. [Ann Emerg Med. 2016;67:9-14.] Please see page 10 for the Editor’s Capsule Summary of this article. A feedback survey is available with each research article published on the Web at www.annemergmed.com. A podcast for this article is available at www.annemergmed.com. 0196-0644/$-see front matter Copyright © 2015 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2015.07.497 INTRODUCTION Background Acute pain is an adverse stimulus commonly experienced by children. Despite the magnitude of effects that it can have on a child, it is often inadequately treated. 1 Early and appropriate pain management in the emergency department (ED) is an important aspect of pediatric care, especially in children who experience limb fractures or joint dislocations. These patients are prone to severe pain and psychological distress, and should be treated with pharmacologic analgesia, such as an opioid medication, as soon as possible. 2,3 Nevertheless, reports from the United States have revealed that ED pain management of injured children appears to be suboptimal. 4-7 Studies in the adult population have shown that ethnicity and race might be associated with disparities in analgesia and opioid treatment in ED patients with limb fractures. 8-12 For US children, studies from early 2000 reported regional differences in analgesic treatment. Black children with orthopedic injuries were the least likely to receive parenteral analgesia and were triaged to have longer ED waiting times compared with white children. 13-15 A recent analysis of a nationally representative sample of pediatric ED visits in the United States (2005 to 2010) revealed no ethnicity-based differences in analgesia administration but found hospital-level disparities opioids use. 16 In Israel, a previous study on labor pain reported that ethnicity had an influence on medical staff’s assessment of pain. 17 Importance The population of northern Israel includes Jews (majority group) and Arabs (minority group). In this bi- ethnic population, ethnicity may have an influence on ED pain management. If interethnic differences in pain Volume 67, no. 1 : January 2016 Annals of Emergency Medicine 9 PEDIATRICS/ORIGINAL RESEARCH Downloaded from ClinicalKey.com at Maimonides Medical Center - JC December 03, 2016. For personal use only. No other uses without permission. Copyright ©2016. Elsevier Inc. All rights reserved.