Inequities in Timeliness of Pain Management of Fractures in the Pediatric Emergency Department

BACKGROUND AND OBJECTIVE Children frequently present to emergency departments (EDs) with fractures. We sought to evaluate for racial and ethnic differences in the timeliness of pain management for children with fractures in a pediatric ED. METHODS This cross-sectional study of electronic health record data between January 1, 2019, and December 22, 2022, at an urban pediatric ED included patient encounters with International Classification of Diseases, Tenth Revision codes indicating long bone fracture for patients younger than 21 years. We used Cox regression and restricted mean survival time analyses to evaluate for racial and ethnic differences in provision and timeliness of analgesia, adjusting for sex, insurance type, triage level, mode of arrival, pain score, location of injury, and use of procedural sedation, with age as an effect modifier. RESULTS Of 3869 eligible visits, 38.8% identified as non-Hispanic (NH) Black, 30.9% Hispanic, 21.0% NH-white, and 9.3% as other races. Inequity was present regarding opioid analgesia for children aged 10 years and older: NH-Black and Hispanic children were less likely to receive opioids compared with NH-white children (hazard ratio [HR] 0.7 [95% CI 0.6–0.9] and HR 0.7 [95% CI 0.6–0.9], respectively). For patients aged 10 years and older, NH-Black and Hispanic patients waited longer to receive opioids compared with NH-white patients (76.6 minutes, P < .05; 68.4 minutes, P < .05, respectively). CONCLUSIONS Black and Hispanic children aged 10 years and older with fractures experience inequities in both provision and timeliness of opioid analgesia, suggesting that these patients may experience adultification in the ED. Further investigation is warranted to understand the drivers of these findings and to promote antiracist health care systems.