Disparities in Pain Management for Pediatric Femur Fractures Highlight Need for Equity in Care
Study Found Regional Anesthesia is Underused Nationwide and Less Likely to be Offered to Children from Lower Socioeconomic Backgrounds
Pediatric femur fractures represent a significant challenge in orthopedic practice, often necessitating surgical intervention for optimal recovery. Yet, while pain management in these cases is crucial not only for immediate comfort but also for long-term outcomes, a recent study published in Injury by New York Medical College faculty and students found that not only were patients from lower socioeconomic backgrounds less likely to receive peripheral nerve block (PNB), but overall regional anesthesia for pediatric femur fractures was underutilized nationally.
“The results ultimately did not come as a surprise,” says Kelsey Murray, SOM Class of 2027, the lead author on the study. “There is a stark dichotomy in the United States when it comes to public versus private health insurance and the coverage that comes with each. Historically, those who come from a socioeconomically disadvantaged background are those who have either public insurance or none at all. This has a large impact on the care they can receive and consequently the resources that they are provided with, which tend to be limited.”
Utilizing data from the 2016–2020 National Inpatient Sample, the researchers found that among the 43,605 pediatric patients who underwent femur fracture repair, only one percent received PNB, which provides targeted pain relief, while minimizing opioid exposure, and only 0.1 percent received a spinal block (SB).
“Our analysis revealed that PNB was less likely to be administered to patients from lower socioeconomic status backgrounds, those with subtrochanteric fractures, or those requiring delayed repair,” says Murray. “Conversely, PNB was associated with reduced healthcare resource utilization (HRU), such as hospital length of stay, total hospital charges, and discharge disposition, while SB was linked to increased HRU. Our study highlights the need for standardized guidelines and interventions to address these disparities, ensuring equitable access to effective pain management techniques in pediatric orthopedic care.”
