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A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

Siddiqui, Ammar BA*; Belland, Laura MD*; Rivera-Reyes, Laura MPH*; Handel, Daniel MD; Yadav, Kabir MD; Heard, Kennon MD§; Eisenberg, Amanda MD; Hwang, Ula MD*

doi: 10.1097/MLR.0000000000000430
Original Articles

Background: Previous studies examining sex-based disparities in emergency department (ED) pain care have been limited to a single pain condition, a single study site, and lack rigorous control for confounders.

Objective: A multicenter evaluation of the effect of sex on abdominal pain (AP) and fracture pain (FP) care outcomes.

Research Design: A retrospective cohort review of ED visits at 5 US hospitals in January, April, July, and October 2009.

Subjects: A total of 6931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249) were included.

Measures: The primary predictor was sex. The primary outcome was time to analgesic administration. Secondary outcomes included time to medication order, and the likelihood of receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain score, ED crowding, and triage acuity.

Results: On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP women: 112 (65–187) minutes, men: 96 (52–167) minutes, P<0.001] and ordering [women: 84 (41–160) minutes, men: 71 (32–137) minutes, P<0.001], whereas women with FP did not (Administration: P=0.360; Order: P=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR=0.766; 95% CI, 0.670–0.875; P<0.001), whereas women with FP were not (P=0.357).

Discussion: In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease sex disparities in pain care should take type of pain into account.

*Emergency Department, Icahn School of Medicine at Mount Sinai, New York, NY

Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC

Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA

§Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO

Mount Sinai Beth Israel, New York, NY

U.H. was supported by a K23 award from the National Institute on Aging (K23 AG031218).

The authors declare no conflict of interest.

Reprints: Ammar Siddiqui, BA, Emergency Department, Icahn School of Medicine at Mount Sinai, 50 East 98th Street, Apt 4B, New York, NY 10029. E-mail:

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