Racial differences in treatment among patients with acute headache evaluated in the emergency department and discharged home

Background: Prior research has demonstrated the widespread presence of racial disparities in emergency depart-ment (ED) care and analgesia. We hypothesized that racial disparities continue to exist in ED analgesic prescrib-ing patterns, time to analgesia, and time to provider in the treatment of headache.Methods: We performed a retrospective cohort study of patients presenting to a large tertiary academic ED with chief complaint of headache. A structured medical record review was conducted to abstract relevant variables of interest. Patient race was categorized as white or Black, Indigenous, or person of color (BIPOC). Descriptive sta-tistics were used to characterize the cohort and stratified analyses were conducted based on patient race and our key outcome measures of analgesic prescribing patterns, time to analgesia, and time to provider in the treat-ment of headache.Results: White patients were more likely to be assigned an Emergency Severity Index score 2 or 3 and their BIPOC counterparts were more likely to be assigned an ESI score 3 or 4 (p = 0.02). There was no significant difference by race in time to analgesia (p = 0.318), time to provider (p = 0.358), or time to first medication treatment (p = 0.357). However, there were clear differences in prescribing patterns. BIPOC patients were significantly more likely to be treated with acetaminophen (p = 0.042) or ibuprofen (p = 0.015) despite reporting higher pain levels during triage (p < 0.001). White patients were significantly more likely to receive a head CT scan (p < 0.001) or neurology consult (p = 0.003) than their BIPOC counterparts.Conclusion: Racial disparities persist in assessment and type of analgesia for patients being treated for headache in a large academic emergency department.(c) 2022 Published by Elsevier Inc.

Automated summary

Racial disparities persist in the assessment and type of analgesia for patients being treated for headache in a large academic emergency department. There are differences in the assigning of Emergency Severity Index scores and prescribing patterns between white patients and BIPOC patients. White patients are more likely to receive special tests and consultations.