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ABSTRACTS

 

Agency-Level Disparities in Prehospital Analgesia Rates for Black Patients with Severe Acute Traumatic Pain

Author: Nathaniel Thomas, BA, LP | |

Associate Authors:

Introduction

Nearly a decade of research indicates the need to address disparities in prehospital pain management based on race, with the greatest disparities consistently observed for Black patients. Few studies have investigated agency-level pain management practices. Our objective was to assess agency-level variation in prehospital analgesia rates by patient race.

Methods

We conducted a retrospective cohort analysis using the 2021 ESO Data Collaborative. We included 9-1-1 patients presenting with acute traumatic pain (initial pain score ≥ 6), transported by advanced life support units. Records were excluded if analgesia was provided prior to arrival of the transporting unit. We excluded agencies with less than 52 records in the sample (~1 per week) or less than 10 White and 10 Black patients to generate more stable estimates. We calculated agency dissimilarity indices as the analgesia rate for White patients minus the analgesia rate for Black patients attended by the same EMS agency.

Results

We analyzed records from 421 agencies representing 206,561 encounters for patients with severe acute traumatic pain. The median agency-level analgesia rate was 32% (IQR: 20%-47%) for White patients and 20% (IQR: 11%-30%) for Black patients. The median dissimilarity index was 11% (IQR: 5%-18%) disfavoring Black patients. The analgesia rate was at least 10 percentage points higher for White patients compared to Black patients at 231 (55%) agencies. Agencies with smaller dissimilarity indices (< 10%) tended to have lower overall analgesia rates (median analgesia rate: 20%, IQR: 12%-31%) compared to agencies with dissimilarity indices > 10% (median analgesia rate: 36%, IQR: 25%-46%).

Conclusion

At the midpoint of EMS agency-level performance, fewer than 1 in 3 White patients with severe acute traumatic pain received prehospital analgesia while fewer than 1 in 5 Black patients received prehospital analgesia. Over half of EMS agencies showed a disparity in analgesia rates of at least 10 percentage points disfavoring Black patients. Disparities were smaller at agencies that treated pain less frequently overall, suggesting that efforts to improve prehospital pain management may not affect patients equitably. Future work is needed to assess agency-level disparities among other minority racial/ethnic patient groups.