Retrospective Analysis of Disparities in Timing of Prehospital and Emergency Department Pain Management by Sex and Age

Introduction: Acute long bone fractures, such as femur and humerus fractures, frequently lead to emergency department (ED) visits and require timely pain management. However, disparities in analgesia administration persist across age and sex. This study investigates how these intersecting patient characteristics affect the timing and receipt of analgesia in both prehospital and ED settings. Methods: We conducted a retrospective cohort study of adults (≥ 18 years of age) presenting to a Level I trauma center ED in 2022 with femur or humerus fractures. Demographics, analgesia timing, and receipt in both prehospital and ED settings were extracted from medical records. Our analysis included all forms of initial analgesic administration, including both narcotic and non-narcotic medications. We further categorized treatments to distinguish between any analgesia and narcotic analgesia. Multivariable Poisson and logistic regression models were used to assess disparities, adjusting for triage acuity, arrival method, initial pain score, and prehospital analgesia. Results: Among 553 patients, 75% were ≥ 65 of age and 63% were female. Older adults experienced significantly longer delays to ED analgesia compared to younger adults (median 81 vs 44 minutes; +54.9% adjusted delay; P .001) and were less likely to receive prehospital analgesia (44% vs 66%; odds ratio 2.52; P .001). Sex-based disparities were also evident: females waited longer than males for ED analgesia (median 76 vs 57 minutes; +12.9% adjusted delay; P .001). Among those who received prehospital analgesia, females waited 43% longer than males for subsequent ED pain treatment (median 72 vs 30 minutes; P .001). Conclusion: Age and sex disparities exist in both prehospital and ED pain management for long bone fractures. Older adults were less likely to receive prehospital analgesia and experienced prolonged delays in the ED. Female patients had longer ED wait times for analgesia, especially following prehospital treatment administered by emergency medical services responders.