The influence of patient sex on paramedic administration of analgesia for acute abdominal pain in an Australian ambulance service

Abstract

Objective: Pain is a subjective experience that encapsulates a physical, emotional, and mental response. An individual's sex is a factor that may influence how pain is experienced. It can be assumed that if females and males present with pain differently, then pain management may also differ. This research aimed to determine the influence of patients’ sex on paramedic administration of analgesia in cases of acute abdominal pain. Methods: A retrospective analytical cohort study included patients between the ages of 16 and 65 with a complaint of abdominal pain who were seen by paramedics employed by a jurisdictional ambulance service between July 2019 and June 2020. The data extracted included sex, age, pain score, type of analgesia administered, and analgesia dosage. The data were analysed using descriptive statistics, chi-square tests, and univariate and multivariate logistic regression. 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  =  8456; 32%). Chi-square testing identified significant associations between sex and analgesic administration (χ2(1, n  =  26,417)  =  7.32, p  =  .01, Φ = −0.02) and opioid administration (χ2(1, n  =  26,417)  =  25.51, p < .001, Φ = 0.03). Multivariate regression identified that sex had no influence on analgesic administration in general, however found that male sex was a statistically significant predictor of opioid administration. Adjusted for age and pain severity, females were at lower odds of opioid administration than males (adjusted odds ratio 0.86; 95% confidence interval 0.80–0.91; p < .001). Conclusions: Equity in pain management was demonstrated in relation to overall analgesic administration between the sexes. However, this research suggests that while females presented more commonly with abdominal pain, females had lower odds of being administered an opioid than their male counterparts. Further research is required on gender bias in relation to abdominal pain management practices by paramedics, to promote equitable access to analgesia.