Racial/Ethnic Variation in Emergency Department Care for Children With Asthma

Zook, Heather G.; Payne, Nathaniel R.; Puumala, Susan E.; Ziegler, Katherine; Kharbanda, Anupam B.

doi:10.1097/pec.0000000000001282

Cited by 29 publications

(28 citation statements)

References 40 publications

(54 reference statements)

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“…Hispanic ethnicity was associated with a lower odds ratio of revisit, but not hospital readmission. Pediatric studies in the past found that more readmissions and ER visits were associated with Hispanic ethnicity, 24 , 25 , 26 , 27 , 28 , 29 but our results indicate the converse may be true for newborn infants. Simon et al 30 found that irrespective of insurance status, Latino children have lower rates of ER injury visits, perhaps due to different healthcare seeking behavior, and it is possible that similar differences in healthcare seeking behavior, cost, or access to care account for lower revisits but similar hospitalization rates in Hispanics.…”

Section: Discussioncontrasting

confidence: 86%

Epidemiology of readmissions in early infancy following nonelective cesarean delivery

et al. 2020

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Objective: Determine incidence and risk factors for readmissions in early infancy Study Design: Secondary analysis of data from the Cesarean Section Optimal Antibiotic Prophylaxis trial. All unplanned revisits (unplanned clinic, ER visits, and hospital readmissions) and hospital readmissions (initial discharge to 3-month follow-up) were analyzed. Results: 295 (15.9%) of 1850 infants had revisits with risk factors being ethnicity (adjusted odds ratio (aOR): 0.6 for Hispanic), maternal postpartum antibiotics (1.89), azithromycin treatment (1.22), small for gestational age (1.68), apnea (3.82), and hospital stay after birth >90th percentile (0.49). 71 (3.8%) of 1850 infants were readmitted with risk factors being antenatal steroids (aOR 2.49), elective repeat C/section (0.72), postpartum maternal antibiotics (2.22), O 2 requirement after delivery room (2.82), and suspected/proven neonatal sepsis (0.55). Conclusion(s): Multiple risk factors were identified, suggesting potential impact on the neonatal microbiome (maternal postpartum antibiotics) or issues related to access/cost of care (Hispanic ethnicity associated with fewer revisits).

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Section: Discussioncontrasting

confidence: 86%

Epidemiology of readmissions in early infancy following nonelective cesarean delivery

et al. 2020

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“… 43 There are many examples of imaging overuse among White children, with no differences in clinical outcomes. For example, compared with non-White children, White children have higher rates of advanced imaging for abdominal pain and abdominal trauma 9 , 10 , 44 and chest radiographs for bronchiolitis, 11 asthma, 12 and chest pain. 45 Similarly, a multicenter study observed that White children with head trauma had higher rates of CT than non-White children, 46 even among those at the lowest risk for substantial injury.…”

Section: Discussionmentioning

confidence: 99%

“…Studies of racial and ethnic differences in pediatric diagnostic imaging 8 , 9 , 10 , 11 , 12 have shown higher rates of selected imaging use in non-Hispanic White children compared with non-White children. However, these studies were limited in scope, focusing on a single imaging modality for a specific condition.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019

et al. 2021

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Key Points Question Does the use of diagnostic imaging for children receiving care in US pediatric emergency departments (EDs) differ by race and ethnicity? Findings This multicenter cross-sectional study of more than 13 million pediatric ED visits to 44 children’s hospitals demonstrated that non-Hispanic Black and Hispanic patients were less likely to undergo diagnostic imaging compared with non-Hispanic White patients. Meaning In these findings, race and ethnicity appear to be independently associated with imaging decisions in the pediatric ED, highlighting the need to better understand and mitigate these disparities.

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“…For example, non-White adolescents are more likely to be tested for sexually transmitted infections than White adolescents (35) and physicians are more likely to order laboratory and radiologic tests for White children in comparison to non-White children (38). White children have higher triage acuity scores than their Black counterparts for the same conditions, have shorter wait times and are less likely to leave the emergency department without being seen (39)(40)(41). Why these disparities exist is not clear.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Pain Management of Children With Limb Fractures or Suspected Appendicitis: A Retrospective Cross-Sectional Study

et al. 2021

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Objective: To evaluate whether racial/ethnical differences in analgesia administration existed in two different cohorts of children with painful conditions: children with either limb fracture or suspected appendicitis.Methods: Retrospective cross-sectional analysis of children visiting a pediatric emergency department (Boston Children Hospital) for limb fracture or suspected appendicitis from 2011 to 2015. We computed the proportion of children that received any analgesic treatment and any opioid analgesia. We performed multivariable logistic regressions to investigate race/ethnicity differences in analgesic and opioid administration, after adjusting for pain score, demographics and visit covariates.Results: Among the 8,347 children with a limb fracture and the 4,780 with suspected appendicitis, 65.0 and 60.9% received any analgesic treatment, and 35.9 and 33.4% an opioid analgesia, respectively. Compared to White non-Hispanic Children, Black non-Hispanic children and Hispanic children were less likely to receive opioid analgesia in both the limb fracture cohort [Black: aOR = 0.61 (95% CI, 0.50–0.75); Hispanic aOR = 0.66 (95% CI, 0.55–0.80)] and in the suspected appendicitis cohort [Black: aOR = 0.75 (95% CI, 0.58–0.96); Hispanic aOR = 0.78 (95% CI, 0.63–0.96)]. In the limb fracture cohort, Black non-Hispanic children and Hispanic children were more likely to receive any analgesic treatment (non-opioid or opioid) than White non-Hispanic children [Black: aOR = 1.63 (95% CI, 1.33–2.01); Hispanic aOR = 1.43 (95% CI, 1.19–1.72)].Conclusion: Racial and ethnic disparities exist in the pain management of two different painful conditions, which suggests true inequities in health care delivery. To provide equitable analgesic care, emergency departments should monitor variation in analgesic management and develop appropriate universal interventions.

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Racial/Ethnic Variation in Emergency Department Care for Children With Asthma

Cited by 29 publications

References 40 publications

Epidemiology of readmissions in early infancy following nonelective cesarean delivery

Epidemiology of readmissions in early infancy following nonelective cesarean delivery

Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019

Racial and Ethnic Disparities in Pain Management of Children With Limb Fractures or Suspected Appendicitis: A Retrospective Cross-Sectional Study

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