Racial/Ethnic Differences in ED Opioid Prescriptions for Long Bone Fractures: Trends Over Time

* Abbreviations: aOR — : adjusted odds ratio CI — : confidence interval ED — : emergency department RR — : relative reduction Pain caused by long bone fractures is a common reason for opioid prescribing in the emergency department (ED) setting.1 Approximately 40% of opioid overdose deaths involve a prescription,2 and in response, opioid prescribing has declined in the last decade.3 We previously demonstrated racial and/or ethnic disparities in the ED management of pain among children with long bone fractures.4 We now perform this study to investigate whether racial and/or ethnic differences in provision of outpatient opioid prescriptions for children discharged from the ED with long bone fractures have attenuated over time. We performed a retrospective cross-sectional study of children aged 4 to <18 years with long bone fractures (clavicle, humerus, ulna, radius, femur, tibia, and fibula, as identified by International Classification of Diseases, Ninth Revision, Clinical Modification , and International Classification of Diseases, 10th Revision, Clinical Modification , diagnosis codes or natural-language processing of radiology reports5) using the Pediatric Emergency Care Applied Research Network Registry, an electronic health record registry of 4 geographically diverse (northeast, south, west, and midwest) pediatric EDs from January 1, 2012, to December 31, 2019.6 We included patients with an Emergency Severity Index of 2 to 4, at least 1 pain score, and disposition of ED discharge. Race and/or ethnicity were categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and … Address correspondence to Monika Goyal, MD, MSCE, Division of Emergency Medicine, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010. E-mail: mgoyal{at}childrensnational.org