The Effect of Ethnicity on Physician Estimates of Pain Severity in Patients With Isolated Extremity Trauma

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Abstract
Objective. —To determine whether physician estimates of pain severity are influenced by patient ethnicity. Design. —Prospective cohort study. Setting. —UCLA Emergency Medicine Center, a level I trauma center, Los Angeles, Calif. Participants. —Hispanic and non-Hispanic white patients presenting to the emergency department with extremity trauma when research assistants were present. Exclusion criteria were patient refusal, altered mentation, or severe injury interfering with the interview process. Main Outcome Measures. —The difference between patient and physician estimates of pain severity as assessed on a visual analog scale for Hispanics and non-Hispanic whites. Results. —A total of 138 non-Hispanic white and 69 Hispanic patients participated in the study. The groups differed in language use, insurance status, and proportions suffering occupational injury. There were no differences between non-Hispanic white and Hispanic patients in patient pain assessments (mean, 39.8 mm vs 39.0 mm, respectively; P=.86), physician pain assessments (mean, 33.6 mm vs 29.7 mm; P=.23), or the disparity between patient and physician pain assessments (mean 6.1 mm vs 9.4 mm; P=.38). The degree of disparity between patient and physician pain assessments remained similar for both groups even after controlling for multiple potential confounders. Conclusions. —Physician ability to assess pain severity does not differ for Hispanic and non-Hispanic white patients. Other explanations for a difference in analgesic practice as a function of ethnicity should be explored. (JAMA. 1994;271:925-928)

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