The influence of patient sex on paramedic administration of analgesia for acute abdominal pain

Abstract

This research aimed to determine the influence of patients’ sex on paramedic administration of analgesia (particularly opioids) in cases of acute abdominal pain. Methodology: A retrospective analytical cohort study was conducted on patients between the ages of 16 to 65 who presented to an Australian jurisdictional ambulance service with complaints of abdominal pain between July 2019 to June 2020. The data that was extracted included sex, age, pain score, type of analgesia administered and analgesia dosage. The data was analysed using descriptive statistics, chi-square tests, and univariate and multivariate logistic regression. The outcomes of interest were to identify if a sex-specific disparity existed in relation to analgesic and opioid administration, opioid dosage, and pain severity. Results: The study sample comprised of 26,417 patients with 61.6% (n = 16,271) females. Analgesia was administered to 65.9% (n = 17,404) of patients, of whom 38.5% (n = 10,177) received an opioid, with the most administered analgesia being morphine (n = 8,456; 32%). Chi-square testing identified significant associations between sex and analgesic administration (?2(1, n = 26,417) = 7.32, p = 0.01, F = -0.02) and sex and opioid administration (?2(1, n = 26,417) = 25.51, p < 0.001, F = 0.03). Multivariate regression identified that sex had no influence on analgesic administration in general, however found that sex was a statistically significant predictor of opioid administration. Adjusted for age and pain severity, females had a lower likelihood of opioid administration than males (aOR 0.86; 95% CI 0.80 – 0.91; p < 0.001). Pain severity was also found to be associated with analgesic administration (severe pain: aOR 65.42; 95% CI 54.04 – 79.21; p < 0.001, moderate pain: aOR 8.25; 95% CI 6.81 – 9.99; p < 0.001, and mild pain: aOR 1.95; 95% CI 1.59 – 2.39; p < 0.001) and opioid administration (severe pain: aOR 61.29; 95% CI 42.04 – 89.36; p < 0.001, moderate pain: aOR 10.34; 95% CI 7.06 –15.13; p < 0.001, and mild pain: aOR 1.68; 95% CI 1.10 – 2.55; p = 0.02). Conclusion: Equity in pain management was demonstrated in this research in relation to overall analgesic administration between the sexes. However, this research suggests that while females presented more commonly with abdominal pain, females had a lower likelihood of being administered an opioid than their male counterparts, after adjusting for age and pain severity. Patients of both sexes presenting with a higher pain severity had greater access to analgesic and opioid administration. Further research is required on gender bias in relation to abdominal pain management practices by paramedics, specifically with opioids and to promote equitable access to analgesia.

Date of Award	2023
Original language	English