Study objective: To determine whether ethnicity is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation, in a bi-ethnic population of northern Israel.
Methods: A retrospective cohort study was conducted. All records of patients aged 3-15 years diagnosed with 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 four-year study period, 3782 children with fractures visited the ED, 1245 Arabs and 2537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7-10. The proportion of Arabic and Jewish children who receive opioid therapy was 312/315 (99.05%) and 538/543 (99.08%), respectively (difference 0.03%; 95% confidence interval [CI] -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 eleven-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews respectively, of whom 16 and 27 had pain scores of 7-10. The proportion of Arabic and Jewish children who receive opioid medication was 16/16 (100%) and 26/27 (96%), respectively (difference 4%; 95% CI -16 % to 18%).
Conclusion: Findings suggest that ethnic differences, including during periods of conflicts, have no impact on opioid analgesia in this ED.
