Effect of patient and nurse ethnicity on emergency department analgesia for children with appendicitis in israeli government hospitals

I. Shavit, R. Jacob, N. Friedman, T. Capua, A. Klein, I. Chistyakov, I. Moldaver, D. Krupik, I. Munchak, S. Abozaid, A. Rimon, G. Meirson, R. Leiba, D. M. Cohen

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Ethnicity is a risk factor for disparate Emergency Department (ED) analgesia. We aimed to explore ethnic variations in the administration of ED analgesia to children with acute appendicitis in Israeli government hospitals. Methods: Children discharged with an International Classification of Disease-Ninth Revision diagnosis of acute appendicitis between 2010 and 2015 were included. The association between patient ethnicity (Jewish, Arab) and analgesia administration (any, opioid) was assessed. Age, gender, triage category, pain score and time of arrival were tested as possible confounders. The effect of patient–nurse ethnic discordance (PNED) was examined. Results: Overall, 4714 children with acute appendicitis, 3520 Jewish and 1194 Arab, were cared for in the EDs; 1516 (32.2%) received any analgesia and 368 (7.8%) opioid analgesia. Stratified by pain score, no statistical differences were found in the administration of any or opioid analgesia between Jewish and Arab patients with either severe pain or moderate pain. In multivariate modelling adjusted for pain score and triage category, the rates of any analgesia for Arab and Jewish patients were 31.8% (95% CI, 30.9–32.6) and 36.5% (95% CI, 36.0–36.9), adjusted OR (aOR) = 1.16 (95% CI, 0.98–1.38), respectively. The rates of opioid analgesia for Arab and Jewish patients were 8.5% (95% CI, 8.2–8.9) and 7.9% (95% CI, 7.3–8.7), aOR = 0.77; (95% CI, 0.59–1.22), respectively. Jewish and Arab nurses treated proportionally fewer patients from the opposite ethnicity with any analgesia (p < 0.01). Conclusion: Emergency Department analgesia was markedly low, and not associated with patient ethnicity. PNED was associated with decreased rates of analgesia. Significance: Emergency Department analgesia for children with acute appendicitis in Israeli government hospitals is markedly low. Patient–provider ethnic discordance may negatively influence the provision of analgesia. Significant efforts should be undertaken in order to increase analgesia provision rates and reduce social inequality.

Original languageEnglish
Pages (from-to)1711-1717
Number of pages7
JournalEuropean Journal of Pain
Issue number10
StatePublished - Nov 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 European Pain Federation - EFIC®


The study was partially funded by two pharmaceutical companies, RAFA Ltd (5 Shlomo Halevi, Har Hotzvim, P.O. 405, Jerusalem, 97770, Israel) and BioAvenir Ltd (1 David HaMelech St, Herzliya Pituach, Israel). The pharmaceutical companies provided funding for data collection. The companies had no role in the design of the study; in the collection, analysis and interpretation of the data; in the writing of the manuscript; or in the decision to submit the paper for publication.

FundersFunder number
BioAvenir Ltd
Herzliya Pituach, Israel


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