Some patients less likely to receive opioid or ketamine analgesia for traumatic injuries

Key takeaways:

• Black patients were the least likely to receive nonoral opioid or ketamine analgesia for painful injuries.
• Native American and Alaskan Native patients also were less likely to have their pain scored or treated.

Multiple diverse patient groups were less likely to have pain scores recorded or receive opioid or ketamine analgesia for pain compared with white patients, researchers found.

“Despite the importance of prehospital pain management and known disparities by race and ethnicity in the hospital setting, most studies continue to demonstrate inequities in prehospital pain medication administration,” Dalton C. Brunson, BA, an MD student at Stanford Medicine, and colleagues wrote in JAMA Network Open.

However, they said prior studies using data from the National Emergency Medical Services Information System (NEMSIS) “did not have the advantage of a pain score variable.”

The researchers used a newly available pain score field in NEMSIS to determine patients’ level of pain and whether they were given analgesia in the event of a high pain score.

The study cohort included 4,781,396 emergency medical service activations for acute traumatic injury from 2019 to 2021. Patients had a mean age of 59 years, and 52.2% were women.

The researchers found that all racial and ethnic groups had a lower adjusted OR of having a pain score recorded vs. white patients, with the lowest among American Indian and Alaskan Native patients (adjusted OR = 0.74; 95% CI, 0.71-0.76).

Additionally, among patients who had a recorded pain score between 7 to 10 out of 10, American Indian and Alaskan Native patients (aOR = 0.53; 95% CI, 0.5-0.56) and Black patients (aOR = 0.53; 95% CI, 0.52-0.54) were half as likely as white patients to receive opioid or ketamine analgesia.

Notably, this disparity occurred despite Black patients being nearly as likely to have a pain score recorded (aOR = 0.96; 95% CI, 0.95-0.97) as white patients.

The disparities could not be fully explained by the NEMSIS data and “reflect complex social dynamics,” they said.

“One possible dynamic is the opioid epidemic, which can cause people both to decline opioids out of fear of potential drug addiction and, conversely, to inflate their pain score to increase the chances of receiving opioids,” the researchers wrote.

Additionally, the researchers found that pain management in the prehospital setting was often inconsistent with current recommendations. For example:

• 31.5% of patients with an acute traumatic painful injury did not have a pain score recorded.
• 63.5% of patients with a high pain score did not receive analgesia.

“Subsequent efforts to measure and improve prehospital patient-centered outcomes would benefit from national and state efforts to include race and ethnicity data collection in all future patient care reports,” Brunson and colleagues concluded.