PEM physician, assistant professor Pediatric Emergency Medicine, University of Ottawa Faculty of Medicine, CHEO Ottawa, Ontario, Canada
Background: Undertreatment of pain in the emergency department (ED) is well recognized and is affected by age, sex and race. In the United States, racialized populations are less likely to receive opioids for pain than White patients. In Canada, race-based data is not routinely collected, hindering its study; however, Ontario’s Marginalization index (ON-Marg) provides data regarding social marginalization by geographic area, and includes ethno-racial, economic, age-based and social marginalization indices. Objective: To determine if social marginalization is associated with administration of opioid analgesics to children presenting with pain to a Canadian ED. Design/Methods: Our retrospective cohort study utilized our institution’s electronic data warehouse to examine analgesic administration among children < 18 years who presented to our pediatric ED between 2018-2021 with appendicitis, burns or femur fractures. Our primary outcome measure was the administration of opioid analgesics in the ED. Secondary outcomes included non-opioid analgesic administration and time to first opioid and non-opioid analgesic. Social marginalization was measured using the 5-level ON-Marg summary score. Multivariable logistic regression was used to examine the association between level of marginalization and analgesic administration adjusted for triage category, age and sex. Cure modeling was used to derive hazard ratios (HR) estimating the effect of level of marginalization on time to analgesic administration adjusted for triage category, age, sex, time to physician assessment and length of stay in the ED. Results: Our final cohort included 1200 children. Mean participant age was 10.8 years (SD 4.4), 478 (39.8%) were female, 960 (80.0%) had appendicitis, 232 (19.3%) had a femur fracture and 8 (0.7%) had burns. Overall, 320 (26.7%) children received opioids analgesia and 891 (74.2%) received non-opioids analgesia. There was no significant association between the administration of opioid or non-opioid analgesia in the ED and ON-Marg summary score (opioid adjusted OR 1.11 [0.95, 1.29]/non-opioid adjusted OR 1.01 [0.87, 1.18]). Similarly, there was no association between time to administration of analgesics and ON-Marg score (opioids adjusted HR 0.99 [0.8, 1.23]/non-opioid adjusted HR 0.98 [CI 0.89, 1.06]).
Conclusion(s): In our single centre study, we did not find an association between a provincial measure of marginalization and administration of analgesics to children presenting to the ED with painful conditions. Large scale national studies are needed to fully explore this issue.
