Researchers Find Racial Bias in Treatment of Kids with Appendicitis


Researchers using a national survey data base from 2003 to 2010 found that black children with acute appendicitis, an extremely painful condition, were less likely than white children to get painkillers in the emergency room. And only about half of children of any race got painkillers even though it is common protocol to administer painkillers in cases of appendicitis.

“Black patients with moderate pain were less likely to receive any analgesia, and black patients with severe pain were less likely to be treated with opioids,” Dr. Monika Goyal of the Children’s National Health System in Washington and colleagues wrote in the Journal of the American Medical Association’s JAMA Pediatrics.

Why does this happen? It may be a combination of unwarranted fear of opioids and an unconscious bias against African-American kids, according to experts. Researchers believed that a study focused on appendicitis cases in general would be helpful, because medical experts broadly agree that the condition merits pain relief measures.

Of the kids in emergency rooms for appendicitis, only 57% received anything for their pain, and only 41% were given an opioid drug. Only 12% of black children were given an opioid for pain relief. Goyal wrote that the findings suggest that there are racial disparities in the administration of opioids to children with appendicitis.

Furthermore, the findings suggest that clinicians are reacting to the pain of patients differently if they are black. And though clinicians recognize the pain equally across racial groups, they more often treat black patients with nonopioid analgesia, but treat white patients with opioid analgesia for the same type and amount of pain.

Although in the past, painkillers were thought to mask symptoms important for diagnosing stomach pain, that mindset has evolved. There are also protocols to make sure that children who need to take opioids to control severe pain will not overdose or become dependent on the medication.

Goyal and his team used data from the National Hospital Ambulatory Medical Care Survey of almost a million respondents age 21 or younger who were diagnosed with appendicitis in an emergency room, according to Kathryn Doyle of Reuters.

“It should also be noted that these data were collected between 2003 and 2010, so some of this information is over a decade old and one might hope that things would be different if the data were collected today,” said Dr. Eric W. Fleegler of Boston Children’s Hospital and Harvard Medical School.

Fleegler’s colleague Dr. Neil Schechter, who coauthored an editorial published with the research, said it should be noted that all patients do not experience pain in the same way, with discomfort depending on the duration of symptoms and degree of inflammation. It is typical, however, to prescribe analgesics for appendicitis , said Fleegler and Schechter.

“The bottom line with all of this is that pain matters, its treatment should be patient centered and individualized, and every patient should feel reassured that they will be treated equally,” Fleegler and Schechter told Reuters Health by email.

They added that hospitals should be using national benchmarks to measure how they are doing compared to others nationwide. If there is more or less opioid use for a given condition, an education program for staff could be helpful.

Yasmin Tayag, reporting for Inverse, says that researchers had documented racial disparities related to waiting times, admission rates, and pain management before this study was completed. This, however, is the first time biased practices have been discovered towards children.

A study, Racism and the Empathy for Pain on Our Skin, published in 2011 in Frontiers in Psychology found that white people do not feel the same level of empathy for physical pain in black people as they do for people of their own race, writes Kenrya Rankin Naasel of ColorLines — a concern that has made its way into the government’s Healthy People 2020 initiative.

09 18, 2015
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