The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?

The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?

VanderBeek BL; Mehlman CT; Foad SL; Wall EJ; Crawford AH

Journal of Pediatric Orthopaedics

2006

Child; Female; Humans; Male; Pain Measurement; Cohort Studies; Logistic Models; Follow-Up Studies; Risk Assessment; Multivariate Analysis; Probability; Chi-Square Distribution; Emergency Service; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; Comparative Study; retrospective studies; Analgesia/methods; Hospital; Fractures; Attitude to Health/ethnology; African Americans/statistics & numerical data; Bone/ethnology/radiography/surgery; Conscious Sedation/methods; European Continental Ancestry Group/statistics & numerical data; Forearm Injuries/ethnology/radiography/surgery; Fracture Fixation/methods; Injury Severity Score

Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.

2006

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