ANZ journal of surgery · 2024
An exploratory study of acute analgesia in tibial shaft fractures: a comparison between Māori and Non-Māori.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Tan Ruth, Coia Martin, Tay Mei Lin, Baker Joseph F
Аннотация
BACKGROUND: Published research suggests Indigenous peoples are less likely to receive analgesia in acute pain settings however there is limited data on the indigenous New Zealand Māori population. The aim of this exploratory pilot study was to compare management between Māori and non-Māori for acute fracture pain in a regional trauma centre.
METHODS: A retrospective review was undertaken for 120 patients with isolated tibial shaft fractures presenting at a tertiary level trauma center between 2015 and 2020. Outcome measures reflected the patient journey including type of analgesia charted pre-hospital, in the ED and on the ward.
RESULTS: Out of 104 matched patients, 48 (46%) were Māori and 65% were male. Fewer Māori received pre-hospital analgesia compared with non-Māori (odds ratio 0.29, p = 0.006). Pain scores were similar on arrival to ED (6.1 ± 3.5 versus 5.4 ± 2.7, p = 0.2). Once at hospital, there were similar rates of prescribed analgesia (paracetamol, NSAIDs, synthetics, or opioids) both in ED and the ward. Time to analgesia were also similar for both groups (72 ± 71 min versus 65 ± 63 min, P > 0.9).
DISCUSSION: We found differences in pre-hospital administration of analgesia between Māori and non-Māori patients with tibial shaft fractures. However once in hospital although there was a trend towards lower prescribing for Māori, there were no significant differences. Exploring the reasons underpinning this difference and the development of robust analgesic guidelines for tibial shaft fractures may help in reducing this inequity in care, particularly in the pre-hospital setting.
METHODS: A retrospective review was undertaken for 120 patients with isolated tibial shaft fractures presenting at a tertiary level trauma center between 2015 and 2020. Outcome measures reflected the patient journey including type of analgesia charted pre-hospital, in the ED and on the ward.
RESULTS: Out of 104 matched patients, 48 (46%) were Māori and 65% were male. Fewer Māori received pre-hospital analgesia compared with non-Māori (odds ratio 0.29, p = 0.006). Pain scores were similar on arrival to ED (6.1 ± 3.5 versus 5.4 ± 2.7, p = 0.2). Once at hospital, there were similar rates of prescribed analgesia (paracetamol, NSAIDs, synthetics, or opioids) both in ED and the ward. Time to analgesia were also similar for both groups (72 ± 71 min versus 65 ± 63 min, P > 0.9).
DISCUSSION: We found differences in pre-hospital administration of analgesia between Māori and non-Māori patients with tibial shaft fractures. However once in hospital although there was a trend towards lower prescribing for Māori, there were no significant differences. Exploring the reasons underpinning this difference and the development of robust analgesic guidelines for tibial shaft fractures may help in reducing this inequity in care, particularly in the pre-hospital setting.