"The Israeli-Palestinian conflicts may be intractable, but in the emergency department, all children are treated the same," says the study's lead author Itai Shavit, MD, of the Paediatric Emergency Department at the Rambam Healthcare Campus in Haifa, Israel. "Having a nurse of the same or different ethnicity did not influence the rate of analgesia, and that held true for the entire four years of the study, including the 11-week period of armed conflict between Palestinians and Israelis in 2014."
The retrospective cohort study reviewed records of the paediatric ED's patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation. Researchers collected and analysed data on demographics (including patient ethnicity and nurse ethnicity), pain level and pain medication. The research team reported these key findings:
- Of 315 Arab children with pain scores between seven and 10 (out of 10), 312 (99.05 percent) received opioid therapy.
- 99 of these Arab children (31.4 percent) were treated by Arab nurses, and 98 of those received opioids (98.9 percent); 216 were treated by Jewish nurses (68.6 percent), and 214 of those received opioids (99 percent).
- Of 543 Jewish children with pain scores between seven and 10, 538 (99.08 percent) received opioid therapy.
- 351 of these Jewish children were treated by Jewish nurses (64.6 percent), and 348 of those received opioids (98.9%); 192 were treated by Arab nurses (35.4 percent), and 190 of those received opioids (98.9 percent).
During the 11-week period of armed conflict between Palestinians and Jews in 2014, 232 children with fractures visited the paediatric ED of Rambam Healthcare Campus. They included 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10, respectively. The researchers found that 100 percent of Arab children received opioid medication and 96 percent of Jewish children received opioid medication.
Jews are the majority population in northern Israel, which is reflected in the higher number of Jewish patients and nurses in the study, the research team noted.
"Inadequate pain relief in emergency departments is a recognised problem, particularly amongst certain ethnic groups in the United States," says Dr. Shavit. "We believe these good results are in part due to the high levels of professionalism in the nursing staff."
Source: American College of Emergency Physicians
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