Tag Archives: Medical treatment

Disparate Treatment of Black Children for Pain Management

One of my recurring nightmares from a disaster zone where I was working is the sight of a small child lying on the sidewalk dead while people and workers stepped around and over the child. Makes you sick when you think medical personnel could actually do this…

Just when you thought we had left all this behind us…

White Kids Get More Pain Meds Than Black Kids in the Emergency Room

A new study found that in emergency rooms, the odds of a black child being given appropriate pain medication were one-fifth those for a white child.

Appendicitis is painful. Having been lucky enough to experience it in my late twenties myself, I can personally verify this bit of common knowledge. It hurts.

However, despite the clear association between appendicitis and pain, which can be quite severe, the management of that pain is not always consistent. A new study in the journal JAMA Pediatrics finds that there are racial disparities in the medications used to treat it for children in American emergency departments, with black patients far less likely to get more potent pain medication than white ones.

The authors of the study sought to build on previous reports that had documented disparities between white and black patients regarding pain management. They chose appendicitis as their particular focus because it more clearly warrants stronger pain medications. There are many causes of broader categories like abdominal pain, and for some of these treating with opioid medications like morphine or Demerol would be inappropriate. By selecting appendicitis, investigating the proper pain control is less ambiguous.

Using a survey of hospitals conducted annually by the Centers for Disease Control and Prevention (CDC), the study looked at how often any pain medication was prescribed for pediatric patients diagnosed with appendicitis, and beyond that, how often opioids specifically were given. While their results showed no racial difference in how often analgesics as a whole were delivered to control patients’ pain, there was a big difference when it came to opioids.

Black patients received the stronger medications in about 20 percent of overall cases, compared to about 43 percent of white patients. When controlling for additional factors such as ethnicity, age, sex, insurance status, triage level, and pain score, black children were likely to get opioids for their pain about 12 percent of the time, compared to 34 percent for white children.

This disparity remained even when patients rated their pain as moderate, with a 60 percent likelihood for white patients to receive any pain medication at all, compared to only about 16 percent for black patients. When the pain rating was severe, black patients were likely to receive the stronger opioid class of medication about 25 percent of the time, compared to 58 percent for white ones.

In other words, three quarters of the time black children presented to emergency departments complaining of severe abdominal pain from appendicitis, if they received any pain medication at all it was likely to be a comparatively weak choice such as Tylenol. Two thirds of white patients in similar levels of pain were likely to get something like Demerol or morphine.

The results when it comes to the appropriate management of appendicitis weren’t great across the board. Overall, a little less than 60 percent of all patients surveyed received pain medication of any kind. That means a sizeable minority weren’t given anything, which is distressing in itself. As the authors note, good pain control is a benchmark of quality care, and large numbers of kids during the study period weren’t getting it.

Much of this lack may be related to providers’ mistaken belief that appropriately controlling patients’ pain can delay proper diagnosis, which could then delay necessary surgery. Location and severity of pain are among the criteria for diagnosing appendicitis, after all. However, there are numerous studies thatdebunk that misapprehension, and patients who present in pain should have that pain alleviated.

However, the racial disparity in how appendicitis pain was treated is stark in this report. The authors found that the odds of a black child being given appropriate pain medication were one fifth those for a white child. That is egregious.

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Posted by on September 17, 2015 in Domestic terrorism, The New Jim Crow


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Black Children Less Likely to be Treated for Pain in ER

Following on to a number of medical studies the last few years – How race impacts treatment and outcomes…

The pont here being 4 times more black children die due to lack of pre- and post natal care in their first year of life…

Than in all the drive bys by all the so called “Street pirates” in all the cities in the country.

Sp…Why are people abetting this?

Black Children Less Likely to Get Pain Meds in ER

Black children seen in the emergency department for abdominal pain are less likely to receive pain medication than white children, according to a new study.

The research, which also found that black and Hispanic children were more likely to experience an ER stay longer than six hours compared to white children — even when the same tests were ordered — raises questions on how race may affect hospital care when it comes to the youngest patients.

The study was presented Saturday at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Lead study author Dr. Tiffani J. Johnson, pediatric emergency medicine fellow at the Children’s Hospital of Pittsburgh, says she has a strong interest in improving the quality and equity of care that kids receive in the ER.

“If we don’t recognize disparities, we’re never going to be able to close the gaps,” says Johnson.

Johnson and colleagues used data from the CDC’s National Hospital Ambulatory Medical Care Survey, which included more than 2,000 children from 550 hospitals who visited the ER for abdominal pain between 2006 and 2009.

Black children were 39 percent less likely to receive pain medications compared to white children with similar medical situations. When their pain was severe, rated 7 or higher on a pain scale from 0 to 10, an even larger disparity was observed.

Dr. Marilyn Hughes Gaston, a pediatrician and co-director of The Gaston and Porter Health Improvement Center in Potomac, Md., has dedicated much of her professional career to improving the health of poor and minority families.

She said the study’s findings are an essential step towards achieving equality in health care and the focus on kids is especially important.

“Every study like this one gives us more and more information,” says Gaston. “We have to dispel stereotypes and assumptions that interfere with care.”

Children are always at greater risk to be undertreated or mistreated compared to adults because of their limited ability to communicate how they feel. Anything else that negatively impacts their care would be important to identify so that providers can be educated.

So what factors are to blame for this problem? Little is known about pain expression and perception in children, but the issue has been studied extensively in adults.

Past research has shown that race can affect the way that adults express their pain. A 2002 study published in the International Journal of Intercultural Relations found that black patients were less likely to disclose the fact that they were in pain than their white counterparts. When they did discuss their pain they were less likely to describe its intensity.

And doctors might also be less skilled in recognizing the pain of certain races. Specifically, doctors were almost twice as likely to underestimate the pain of black patients compared to other ethnicities in a 2007 study from the University of Tennessee College of Medicine.

Whether either of these findings applies to pain in children is simply not known. Johnson says we need additional studies to find out exactly what factors lead to variations in care.

“Now we need to look at where these differences are coming from,” says Johnson. “Are they at the patient level, the parent level or the physician level?”

In the meantime, Johnson says, her study’s findings offer an important reminder to doctors.

“I hope that providers caring for children will recognize this,” she says, “and make efforts to ensure they are proving appropriate pain control for children of all ethnicities.”


Posted by on April 30, 2012 in The New Jim Crow


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