Association of race and socioeconomic status with time to pain control among pediatric trauma patients managed nonoperatively

Abstract

BACKGROUNDFew studies have evaluated racial/ethnic inequities in acute pain control among hospitalized injured children. We hypothesized that there would be inequities in time to pain control based on race/ethnicity and socioeconomic status.METHODSWe performed a retrospective cohort study of all injured children (7–18 years) admitted to our level 1 trauma center between 2010 and 2019 with initial recorded numerical rating scale (NRS) scores of >3 who were managed nonoperatively. A Cox regression survival analysis was used to evaluate the time to pain control, defined as achieving an NRS score of ≤3.RESULTSOur cohort included 1,787 admissions. The median age was 14 years (interquartile range, 10–18), 59.5% were male, 76.6% identified as White, 19.9% as Black, and 2.4% as Hispanic. The median initial NRS score was 7 (interquartile range, 5–9), and the median time to pain control was 4.9 hours (95% confidence interval, 4.6–5.3). Insurance status, as a marker of socioeconomic status, was not associated with time to pain control (p= 0.29). However, the interaction of race/ethnicity and deprivation index was significant (p= 0.002). Specifically, the socioeconomic deprivation of a child's home neighborhood was an important predictor for non-White children (p<0.003) but not for White children (p= 0.41) and non-White children from higher deprivation neighborhoods experienced greater times to pain control (hazard ratio, 1.55; 95% confidence interval, 1.16–2.07). Being female, older, presenting with higher initial NRS scores, and having history of attention-deficit/hyperactivity disorder were all associated with longer times to pain control. Other injury characteristics and psychiatric history were evaluated but ultimately excluded, as they were not significant.CONCLUSIONGreater neighborhood socioeconomic deprivation was associated with prolonged time to pain control for non-White children admitted after injury and managed nonoperatively. Further work is needed to understand inequities in pain control for injured patients.LEVEL OF EVIDENCEPrognostic and Epidemiological; Level IV.