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Assessment of Disparities in the Use of Anxiolysis and Sedation Among Children Undergoing Laceration Repair

  • Holly Brodzinski
    Correspondence
    Address correspondence to Holly Brodzinski, MD, MPH, Cincinnati Children's Hospital Medical Center, ML 2008, 3333 Burnet Ave, Cincinnati, Ohio 45229.
    Affiliations
    From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Brodzinski); Division of Emergency Medicine, Center for Health Care Quality, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Iyer); and University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Grupp-Phelan)
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  • Srikant Iyer
    Affiliations
    From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Brodzinski); Division of Emergency Medicine, Center for Health Care Quality, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Iyer); and University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Grupp-Phelan)
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  • Jacqueline Grupp-Phelan
    Affiliations
    From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Brodzinski); Division of Emergency Medicine, Center for Health Care Quality, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Iyer); and University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Grupp-Phelan)
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Published:April 12, 2010DOI:https://doi.org/10.1016/j.acap.2009.12.003

      Objective

      The aim of this study was to determine if race/ethnicity and socioeconomic status (SES) were associated with the provision of anxiolysis and/or sedation among children undergoing laceration repair.

      Methods

      A 1-year cross-sectional sample of children undergoing laceration repair in an urban tertiary-care pediatric emergency department was analyzed. Primary outcomes included the use of nonpharmacologic anxiolysis (presence of a child life specialist), pharmacologic anxiolysis, and procedural sedation. Predictors included race/ethnicity (Caucasian vs minority) and SES (represented by insurance status: private vs none/public). Bivariable analyses provided unadjusted odds ratios (ORs) for the association between predictors and outcomes, and logistic regression was used to obtain adjusted ORs for the provision of anxiolysis and sedation (adjusted for age, gender, acuity, provider type, length of laceration, complexity of repair, time of day, use of a topical anesthetic, and body site of laceration).

      Results

      In the unadjusted analysis, a higher proportion of Caucasian children than minority children received nonpharmacologic anxiolysis and sedation, and a higher proportion of children with high SES received nonpharmacologic anxiolysis compared with children of low SES. However, these associations were not statistically significant once potential confounders were controlled in the adjusted analysis.

      Conclusions

      A very small proportion of children undergoing laceration repair at this single institution received pharmacologic anxiolysis and/or procedural sedation. We did not demonstrate racial/ethnic or socioeconomic disparities with respect to the management of procedure-related anxiety in children.

      Key Words

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