Physician self-identified race and opioid prescription practices in upper extremity injuries in the pediatric emergency department

• Type of Material: Article
• Authors: Joseph Langham, Emory University; Sherita Holmes, Emory University; Janet Figueroa, Emory University; Srikant Iyer, Emory University; Sarah Lazarus, Pediatric Emergency Medicine; Scott Gillespie, Emory University; Carmen Sulton, Emory University
• Language: English
• Date: 2023-02-01
• Publisher: Elsevier Inc.,
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.heliyon.2023.e13351
• Title of Journal or Parent Work: Heliyon
• Volume: 9
• Issue: 2
• Start Page: e13351
• End Page: e13351
• Grant/Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
• Keywords: Long bone fractures; Pain management; Analgesia; Procedural sedation; Pediatrics; Pediatric emergency medicine; Disparities; Emergency medicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Minority children have been shown to receive fewer opioid analgesics for acute pain. Objective: Assess if both White and non-White physicians prescribe fewer opioids to non-White children presenting to the pediatric emergency department (PED) with upper extremity (UE) fractures. Methods: Patients with acute UE fractures were evaluated. Attending physicians provided their self-identified race and consented to analysis of their opioid prescribing practices. Primary outcome was receipt of an opioid prescription at discharge. Bivariate analyses measured the association between patient race and receipt of an opioid prescription; further analysis evaluated the effect of physician race on prescription practices. Generalized linear models measured these associations while controlling for confounders. Results: Thirty-four percent of eligible patients (2754/8155) were discharged with an opioid prescription. There was no statistically significant difference in odds of being discharged with an opioid prescription for non-Hispanic Black (NHB) compared to non-Hispanic White (NHW) patients. There was no statistically significant difference in odds of prescribing opioids by both White physicians and non-White physicians. In patients with the most severe fractures, requiring sedation for reduction, NHB patients had lower odds of receiving an opioid prescription (OR 0.80; 95% CI: 0.65–0.98). Conclusion: Within our institution, NHB patients received fewer opioid prescriptions at discharge for UE fractures. There is no statistically significant association between NHB race and odds of receiving an opioid prescription. In patients sedated for fracture reductions, NHB patients had lower odds of receiving an opioid prescription and non-White physicians had lower odds of prescribing opioids to NHB patients compared to NHW patients.