Background: In the bi-ethnic state of Israel, acute pain management has never been studied on a multicenter level. This study aims to explore the administration of Emergency Department (ED) analgesia to children with acute appendicitis in government hospitals.
Methods: We conducted a retrospective multicenter cohort study of patients attended pediatric EDs of Israeli government hospitals. Children discharged from hospital with an International Classification of Disease-Ninth Revision diagnosis of acute appendicitis between 2010 and 2015, were included. Multivariate regression was used to assess the strength of association between ethnicity and analgesia administration (any analgesia, opioid analgesia). Adjustments were made for age, gender, triage category, pain score, and 24-hour time of arrival. The effect of patient-provider ethnic concordance was assessed.
Results: Overall, 4,714 patients with acute appendicitis, 3,520 Jews and 1,194 Arabs, attended the EDs; 1,516 (32.1%) received any type of analgesia and 368 (7.8%) received opioid analgesia. Arabs were slightly less likely than Jews to receive any type of analgesia 31.8% (95% confidence interval [CI] = 30.9%-32.6%) vs 36.5% (95% CI = 36.0%-36.9%), adjusted odds ratio [aOR] = 1.16, 95% CI = 0.98-1.38, p=0.001. No statistical difference was found in the receipt of opioid analgesia 8.5% (95% CI = 8.2%-8.9%) vs 7.9% (95% CI = 7.3%-8.7%), aOR=0.77, 95% CI = 0.59-1.22, p=0.12. Patient-provider ethnic discordance was associated with lower rates of overall analgesia and opioid analgesia (p<0.0001, and p<0.0001, respectively).
Conclusions: The findings suggest that the rate of analgesia administration is markedly low and that ethnicity influences the provision of analgesia.
