Introduction

Effective pain management in pediatric trauma patients during prehospital care is critical to reduce physiological stress and improve outcomes. However, disparities in analgesic administration based on race and ethnicity have been increasingly recognized as a significant concern in emergency medical services (EMS) systems. This retrospective cohort study investigates these disparities among pediatric trauma patients transported to a single Level I trauma center over a seven-year period, aiming to elucidate factors contributing to unequal pain treatment and identify potential interventions.

Despite a high prevalence of documented pain among pediatric trauma patients, prehospital analgesic administration remains suboptimal. Understanding the influence of demographic and clinical variables on pain medication use is essential to guide equitable and effective pain management strategies in the prehospital setting.

Study Overview

Additional Factors Assessed: Age, socioeconomic status, language barriers, prehospital vascular access, injury mechanism (e.g., motor vehicle collision), and patient/family preferences.

Key Findings

• 82% of patients reported prehospital pain; 67% had pain scores 6460;/10, yet only 35% received pain medication prehospital.
• Black patients were 23% less likely to receive pain medication (adjusted relative rate [aRR] 0.77; 95% CI 0.71-0.84) compared to White patients.
• Hispanic patients were 20% less likely to receive pain medication (aRR 0.80; 95% CI 0.74-0.87) compared to White patients.
• Factors linked to both minority race/ethnicity and lower analgesic use included younger age, lower socioeconomic status, language barriers, lack of vascular access, and motor vehicle collision involvement.
• Overall prehospital pain medication administration increased and disparities decreased over the study period, but inequities persist.

Evidence Synthesis

The findings align with prior research demonstrating racial and ethnic disparities in prehospital pain management among pediatric trauma patients. Hughes Garza et al. provide robust evidence from a large, single-center cohort highlighting persistent inequities despite adjustment for clinical need and other confounders.

Supporting Studies

• Hewes et al., 2022: National database analysis confirming lower likelihood of prehospital analgesic administration in Black children, indicating systemic disparities (PMID: 2).
• Nishijima et al., 2020: Prospective multicenter study found no significant adjusted racial/ethnic disparities in EMS opioid administration, suggesting variability by setting and methodology (PMID: 3).
• Johnson et al., 2018: Air medical transport data analysis showed no adjusted differences in analgesic use by race/ethnicity, highlighting transport modality as a potential modifier (PMID: 4).

Summary Table of Key Studies

Clinical Implications

• EMS systems should implement standardized pain assessment and analgesic protocols to reduce variability and disparities in pediatric pain management.
• Training programs must address implicit bias and cultural competency to improve equitable care delivery.
• Expand use of non-invasive analgesic routes (intranasal, oral) to overcome barriers related to vascular access and language.
• Promote diversity in EMS workforce hiring to enhance cultural sensitivity and trust.

Strengths & Limitations

Future Directions

Prospective multicenter studies are needed to validate these findings across diverse EMS systems and geographic regions. Research should focus on evaluating targeted interventions such as implicit bias training, protocol standardization, and expanded analgesic options to reduce disparities. Additionally, exploring EMS provider perspectives and system-level barriers will inform effective strategies to optimize equitable pediatric pain management.

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