Disparities in the use of anxiolysis or sedation for facial laceration repair in the pediatric emergency department

Objective: To examine the differences in the use of anxiolysis and sedation for facial laceration repair in the pediatric emergency department by patient race, ethnicity, and preferred language. Methods: This was a retrospective cross-sectional analysis of pediatric patients who underwent facial laceration repair in two pediatric emergency departments between January 2015 and December 2024. The primary outcome was receipt of any anxiolysis or sedation prior to laceration repair. We performed bivariate and multivariable mixed-effects logistic regression to evaluate associations between race, ethnicity, language, and the use of sedation. Results: Of the 12,650 patients with facial lacerations who met inclusion criteria, 762 received sedation and 2,769 received anxiolysis only for the repair. Our study population was 51.8% non-Hispanic White, 13.4% non-Hispanic Black, 25.9% Hispanic, 8.5% Other race and ethnicity (including American Indian or Alaska native, Asian, Native Hawaiian or Other Pacific Islander, other (not specified), or patients listing two or more races), and 7.3% spoke a language other than English. Non-Hispanic White children had higher odds of receiving anxiolysis or sedation prior to repair compared with the grand mean (aOR 1.17; 95% CI 1.02, 1.35). There was no significant difference between patient language and administration of anxiolysis or sedation. Conclusion: Among children undergoing facial laceration repair in the pediatric emergency department, differences in the use of anxiolysis and sedation were observed by race and ethnicity, but not by preferred language. Targeted provider education and decision-support tools should be considered to promote equitable use of anxiolysis and procedural sedation in the emergency department.