Racial and Gender-Based Disparities in Opioid Administration for Ocular Trauma

PURPOSE: To investigate how race and other social determinants of health (SDOH) influence prehospital opioid administration for open globe injuries (OGIs) in the United States. METHODS: We analyzed emergency medical service activations for OGIs in the National Emergency Medical Services Information System (NEMSIS) database from 2017-2021, excluding cancellations and cases without patient contact. Demographics, maximum reported pain scores, and administered medications were recorded. Multivariate logistic regression adjusted for pain score was used to identify factors associated with increased likelihood of opioid administration. RESULTS: Among 53,589 OGI cases, females were less likely than males to receive opioids (OR 0.71). Non-White patients were less likely than White patients to receive opioids (African Americans OR 0.37; Hispanics OR 0.83). Urban patients were less likely than suburban patients (OR 0.63), and patients in the Midwest (OR 0.75), Northeast (OR 0.24), and South (OR 0.77) were less likely than those in the West. Cases between 11 pm-7 am were less likely to involve opioid use (OR 0.62). Emergent cases (OR 1.85) and patients aged 66-75 (OR 1.41) were more likely to receive opioids. CONCLUSION: Significant racial, regional, and gender disparities exist in prehospital opioid use for OGIs. Addressing bias, diversifying the workforce, and implementing clearer guidelines may promote equitable pain management in ocular trauma.