Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency

Abstract

To examine inequities in pain assessment and management of hospitalized children with limited English proficiency (LEP) as assessed by (1) self-reported pain prevalence and intensity, and (2) nurse-documented pain assessments and analgesia. A cross-sectional survey of hospitalized children and parent proxies examined preferred language and pain prevalence, intensity, and etiology; subsequent electronic medical record chart review examined demographics, nurse-documented pain scores, and analgesia prescribed for children aged ≤21 years at a tertiary care children's hospital. The primary outcome was a difference of ≥3 points between self-reported and nurse-documented worst pain scores. Descriptive statistics, Fisher's exact tests, and multivariable logistic regression were used to identify differences in outcomes between children with and without LEP. A total of 155 patients (50% children and 50% parental proxies) were interviewed (96% response rate). Of those, 60% (n = 93) reported pain in the previous 24 hours, most frequently because of acute illnesses. Of patients reporting pain, 65% (n = 60) reported a worst pain score of ≥3 points higher than nurse-documented scores; this discrepancy affected more patients with LEP (82%, n = 27) than English-proficient patients (55%, n = 33) (P = .01) with an adjusted odds ratio of 3.2 (95% confidence interval: 1.13-10.31). Patients with LEP were also less likely than English-proficient patients to receive medications at the time of their worst pain (60% vs 82%, P = .03), particularly opioid analgesia (9% vs 22%, P = .04). Children with LEP were more likely to self-report pain scores that exceeded nurse-documented scores and received less medications, particularly opiates. This population may be particularly vulnerable to underassessment and inadequate management of pain.