Fellow Seattle Children's Hospital and University of Washington University of Washington and Seattle Children's Hospital Seattle, Washington, United States
Background: Studies show racial and ethnic disparities in many aspects of emergency department (ED) care including triage, wait time, testing, pain management, and sepsis care. However, there are few studies examining disparities in the treatment of pediatric acute gastroenteritis (AGE) or inequities in the use of antiemetics. Antiemetics are known to reduce the need for IV fluids and hospitalization and are standard care for children with AGE and moderate dehydration.
Objective: The goal of this study is to explore racial and ethnic differences in the care of children with AGE.
Design/Methods: The Pediatric Health Information System (PHIS) was used to conduct a retrospective cohort study of children 6 months-6 years with AGE seen in participating EDs from 1/1/2016-12/31/2018. Cases were identified by ICD-10 codes for AGE. The primary outcome was administration of ondansetron; secondary outcomes were administration of IV fluids and hospitalization. The primary predictor was race/ethnicity; covariates were gender, age, and insurance. Multivariate logistic regression was used to examine the association of race/ethnicity with each outcome.
Results: A total of 78,019 patient visits were included; 25% of patients were non-Hispanic white (NHW), 29% were non-Hispanic black (NHB), 37% were Hispanic, and 9% were other non-Hispanic (NH) race/ethnicity. Compared to NHW patients, NHB (aOR 1.38; CI 1.21-1.57), Hispanic (aOR 1.27; CI 1.11-1.46), and other NH patients (aOR 1.23; CI 1.07-1.41) were more likely to receive ondansetron (Table 1). However, NHB (aOR 0.38; CI 0.33-0.43), Hispanic (aOR 0.44; CI 0.36-0.54), and other NH patients (aOR 0.51; CI 0.44-0.61) were less likely to receive IV fluids (Table 2). Similarly, NHB (aOR 0.37; CI 0.29-0.48), Hispanic (aOR 0.41; CI 0.33-0.5), and other NH patients (aOR 0.52; CI 0.41-0.66) were less likely to be hospitalized (Table 3). Ondansetron use by hospital ranged from approximately 75-95% (Figure 1). Conclusion(s): This large database analysis of EDs around the nation found NHW patients were less likely to receive ondansetron, but more likely to receive IV fluids and hospital admission than other patients. These findings are likely multifactorial and may represent bias, social determinants of health, access to care, or illness severity, among others. This study is limited by its retrospective nature and lack of data on potential confounders such as language or markers of illness severity. Future research is needed to identify contributors of disparities and interventions to reduce inequities in ED care.
Authors/Institutions: Tavis Dickerson-Young, University of Washington/Seattle Children's Hospital, Seattle, Washington, United States; Neil G. Uspal, University of Washington/Seattle Children's Hospital, Seattle, Washington, United States; William B. Prince, University of Washington/Seattle Children's Hospital, Seattle, Washington, United States; Pingping Qu, Seattle Children's Research Institute, Seattle, Washington, United States; Eileen J. Klein, University of Washington/Seattle Children's Hospital, Seattle, Washington, United States
