Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults

Bergmark, Regan W.; Ishman, Stacey L.; Phillips, Katie; Cunningham, Michael J.; Sedaghat, Ahmad R.

doi:10.1002/lary.26671

Cited by 10 publications

(15 citation statements)

References 19 publications

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“…Acute rhinosinusitis Public/no insurance increased ED visits for ARS 13,17 Imaging more likely in metropolitan hospitals, private insurance, higher SES patients 58 Public/no insurance, lower SES more intracranial complications; higher SES more orbital 30 Chronic rhinosinusitis More likely white, privately insured 59 Cystic fibrosis Perioperative PFTs worse in Medicaid patients but improved more than in private insurance 60 Trauma/facial plastics Facial fractures Higher chance ICU course in blacks, males 31 Higher chance violent injury with lower SES 31,61 Public insurance, racial minorities delayed to cleft palate repair 62 General/mixed OSA and OM Medicaid patients less likely to get appointments and longer delay to appointment 33 FEI, strep, sinusitis, hay fever Less likely to be identified in blacks/Hispanics compared to whites 32…”

Section: Rhinologymentioning

confidence: 99%

“…Public/no insurance delayed to CI, worse CI follow-up, more complications 43,44,47 Adenotonsillectomy Medicaid less able to get AT referral 37,57 Acute rhinosinusitis Increased ED visits for ARS 13,17 More intracranial complications 30 Less imaging compared to private insurance 58 Chronic rhinosinusitis More likely privately insured 59…”

Section: Hearing Loss/rehabilitationmentioning

confidence: 99%

“…Within otolaryngology, disparities exist in nearly every subspecialty . Exemplary are decreased survival for ethnic minorities with head and neck cancer, delayed rehabilitation in rural compared to urban hearing loss patients, and higher rates of complications for Medicaid patients undergoing transsphenoidal pituitary surgery .…”

Section: Introductionmentioning

confidence: 99%

“…2,10 Within otolaryngology, disparities exist in nearly every subspecialty. [11][12][13][14][15] Exemplary are decreased survival for ethnic minorities with head and neck cancer, delayed rehabilitation in rural compared to urban hearing loss patients, and higher rates of complications for Medicaid patients undergoing transsphenoidal pituitary surgery. 11,12,15 Similarly within pediatric otolaryngology, disparities have been demonstrated to affect the treatment and outcome of a number of conditions, from otitis media to acute rhinosinusitis to sleep-disordered breathing.…”

Section: Introductionmentioning

confidence: 99%

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Healthcare disparities in pediatric otolaryngology: A systematic review

2017

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Through a variety of study topics, designs, and settings, a growing body of literature documents disparities across the spectrum of pediatric otolaryngology care. The etiologies and manifestations of such disparities are myriad. This evidence suggests the need for interventions to address these disparities at various professional and institutional levels, ideally with methodological rigor to assess the effectiveness of such interventions. Laryngoscope, 128:1699-1713, 2018.

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Section: Rhinologymentioning

confidence: 99%

Section: Hearing Loss/rehabilitationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Healthcare disparities in pediatric otolaryngology: A systematic review

2017

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“…[1][2][3] Such disparities profoundly affect the otolaryngology field as well, altering the treatment and outcomes of conditions in nearly every subspecialty area. [4][5][6][7][8] Within pediatric otolaryngology, inequities range from delays to rehabilitation in hearing loss among patients of low socioeconomic status to higher rates of posttonsillectomy hemorrhage among racial minorities and greater risk of intracranial complications of sinusitis for those with public insurance. [9][10][11][12] Such disparities affect not only individuals but the overall quality of care within the field.…”

mentioning

confidence: 99%

Trends in Pediatric Otolaryngology Disparities Research

Jabbour

Doerfer

Robey

et al. 2018

Otolaryngol.--head neck surg.

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Objectives To describe trends in disparities research within pediatric otolaryngology as evidenced by major meeting presentations and to compare observed trends with those in the realm of patient safety and quality improvement (PSQI). Study Design Retrospective review of presentations at national otolaryngology meetings. Setting Online review of meeting programs. Subjects and Methods Meeting programs from the American Society of Pediatric Otolaryngology, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery Foundation, and Society for Ear, Nose and Throat Advances in Children from 2003 to 2016 were manually searched for pediatric oral and poster presentations addressing disparities and socioeconomic determinants of health, as well as PSQI. Presentation frequency was compared between categories and within each category over time. Results Of 11,311 total presentations, 3078 were related to the pediatric population, and 1945 (63.2%) of those were oral presentations. Disparities-related presentations increased from 0 in 2003 to 17 in 2016. From 2003 to 2009, 9 of 656 (1.4%) presentations involved disparities, as opposed to 70 of 2422 (2.9%) from 2010 to 2016 ( P = .03). The proportion of presentations regarding PSQI also increased: from 42 of 656 (6.4%) in 2003-2009 to 221 of 2422 (9.1%) in 2010-2016 ( P = .01). PSQI presentations remain more common than disparities presentations (9.1% vs 2.9%, P < .001). Conclusion Health care disparities are increasingly addressed in pediatric otolaryngology meeting presentations. Compared with the well-established realm of PSQI, disparities research remains nascent but is gaining attention. Health care reform and quality improvement efforts should recognize the role of socioeconomic factors and include strategies for addressing disparities.

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Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis

Savage,

Kronman,

Sreedhara

et al. 2023

JAMA

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ImportanceAcute sinusitis is one of the most common indications for antibiotic prescribing in children, with an estimated 4.9 million such prescriptions in the US annually. Consensus does not exist regarding the optimal empirical antibiotic.ObjectiveTo compare amoxicillin-clavulanate vs amoxicillin for the treatment of acute sinusitis in outpatient children.Design, Setting, and ParticipantsCohort study of children and adolescents aged 17 years or younger with a new outpatient diagnosis of acute sinusitis and a same-day new prescription dispensation of amoxicillin-clavulanate or amoxicillin in a nationwide health care utilization database. Propensity score matching was used to mitigate confounding.ExposureA new prescription dispensation of amoxicillin-clavulanate or amoxicillin.Main Outcomes and MeasuresTreatment failure, defined as an aggregate of a new antibiotic dispensation, emergency department or inpatient encounter for acute sinusitis, or inpatient encounter for a sinusitis complication, was assessed 1 to 14 days after cohort enrollment. Adverse events were evaluated, including gastrointestinal symptoms, hypersensitivity and skin reactions, acute kidney injury, and secondary infections.ResultsThe cohort included 320 141 patients. After propensity score matching, there were 198 942 patients (99 471 patients per group), including 100 340 (50.4%) who were female, 101 726 (51.1%) adolescents aged 12 to 17 years, 52 149 (26.2%) children aged 6 to 11 years, and 45 067 (22.7%) children aged 0 to 5 years. Treatment failure occurred in 1.7% overall; 0.01% had serious failure (an emergency department or inpatient encounter). There was no difference in the risk of treatment failure between the amoxicillin-clavulanate and amoxicillin groups (relative risk [RR], 0.98 [95% CI, 0.92-1.05]). The risk of gastrointestinal symptoms (RR, 1.15 [95% CI, 1.05-1.25]) and yeast infections (RR, 1.33 [95% CI, 1.16-1.54]) was higher with amoxicillin-clavulanate. After patients were stratified by age, the risk of treatment failure after amoxicillin-clavulanate was an RR of 0.98 (95% CI, 0.86-1.12) for ages 0 to 5 years; RR was 1.06 (95% CI, 0.92-1.21) for 6 to 11 years; and RR was 0.87 (95% CI, 0.79-0.95) for 12 to 17 years. The age-stratified risk of adverse events after amoxicillin-clavulanate was an RR of 1.23 (95% CI, 1.10-1.37) for ages 0 to 5 years; RR was 1.19 (95% CI, 1.04-1.35) for 6 to 11 years; and RR was 1.04 (95% CI, 0.95-1.14) for 12 to 17 years.Conclusions and RelevanceIn children with acute sinusitis who were treated as outpatients, there was no difference in the risk of treatment failure between those who received amoxicillin-clavulanate compared with amoxicillin, but amoxicillin-clavulanate was associated with a higher risk of gastrointestinal symptoms and yeast infections. These findings may help inform decisions for empirical antibiotic selection in acute sinusitis.

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Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults

Abstract: 4. Laryngoscope, 128:299-303, 2018.

Cited by 10 publications

References 19 publications

Healthcare disparities in pediatric otolaryngology: A systematic review

Healthcare disparities in pediatric otolaryngology: A systematic review

Trends in Pediatric Otolaryngology Disparities Research

Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis

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