Racial/ethnic disparities in management of acute gastroenteritis in a pediatric emergency department

Jones, Nathaniel K.; Badolato, Gia M.; Boyle, Meleah D.; Goyal, Monika K.

doi:10.1111/acem.14315

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…We are unaware of any studies specifically examining patient and caregiver preferences related to drug testing; however, we have no reason to suspect that these differ by race/ethnicity, or that Black children and families, in particular, are more likely to request drug testing. For other forms of diagnostic testing (i.e., bloodwork and imaging), White children typically undergo testing at higher rates which stands in contrast to what we observed with drug testing 2,18,19 …”

Section: Discussioncontrasting

confidence: 79%

“…For other forms of diagnostic testing (i.e., bloodwork and imaging), White children typically undergo testing at higher rates which stands in contrast to what we observed with drug testing. 2,18,19 Alternatively, testing differences may represent unwarranted variation driven by health system or clinician factors, including systemic racism and both implicit or explicit biases. Studies show that physicians often express positive attitudes toward White patients and negative attitudes toward Black patients.…”

Section: Discussionmentioning

confidence: 99%

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Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals

Herrera,

Hall,

Alex Ahearn

et al. 2024

Journal of Hospital Medicine

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ObjectivesRacial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non‐Hispanic White children undergo drug testing less often than children from other groups.MethodsWe conducted a retrospective cohort study of emergency department (ED)‐only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self‐harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non‐Hispanic) Asian, (non‐Hispanic) Black, Hispanic, and (non‐Hispanic) White children overall, by condition and patient cohort (ED‐only vs. hospitalized) and across hospitals.ResultsAmong 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05–1.33) than White children. Black–White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18–1.69) but not among ED‐only encounters (aOR: 1.07; 0.92–1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals.ConclusionsHospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals

Herrera,

Hall,

Alex Ahearn

et al. 2024

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…Specifically, Li et al found that non‐Hispanic White children, compared to non‐Hispanic Black and Hispanic children, were significantly more likely to undergo potentially unnecessary imaging for asthma, bronchiolitis, afebrile seizures, head injuries, headaches, and constipation 1 . These findings add to a recent body of literature demonstrating higher rates of potentially unnecessary interventions in the emergency management of non‐Hispanic White children: in addition to higher rates of imaging, 1,3,4 non‐Hispanic White children are more likely to receive antibiotics for viral respiratory illnesses 5 and more likely to receive intravenous (rather than enteral) hydration and undergo laboratory testing in the setting of acute gastroenteritis 6,7 …”

mentioning

confidence: 91%

“…receive antibiotics for viral respiratory illnesses 5 and more likely to receive intravenous (rather than enteral) hydration and undergo laboratory testing in the setting of acute gastroenteritis. 6,7 It is tempting to believe this research has found a silver lining in a health system fraught with health disparities -are non-Hispanic Black and Hispanic children potentially receiving higher quality pediatric emergency care than their non-Hispanic White peers? While we do not minimize the potential for harm from low-value interventions, it is critical that Li et al's findings be interpreted within the larger context of pediatric health inequities.…”

mentioning

confidence: 99%

Low‐value care in pediatric populations: There is no silver lining

Gutman

Holmes

Balhara

2022

Academic Emergency Medicine

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Disparities in Management of Acute Gastroenteritis in Hospitalized Children

Polich,

Mannino-Avila,

Edmunds

et al. 2023

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES Acute gastroenteritis (AGE) is a common health care problem accounting for up to 200 000 pediatric hospitalizations annually. Previous studies show disparities in the management of children from different ethnic backgrounds presenting to the emergency department with AGE. Our aim was to evaluate whether differences in medical management also exist between Hispanic and non-Hispanic children hospitalized with AGE. METHODS We performed a single-center retrospective study of children aged 2 months to 12 years admitted to the pediatric hospital medicine service from January 2016 to December 2020 with a diagnosis of (1) acute gastroenteritis or (2) dehydration with feeding intolerance, vomiting, and/or diarrhea. Differences in clinical pathway use, diagnostic studies performed, and medical interventions ordered were compared between Hispanic and non-Hispanic patients. RESULTS Of 512 admissions, 54.9% were male, 51.6% were Hispanic, and 59.2% were on Medicaid. There was no difference between Hispanic and non-Hispanic patients in reported nausea or vomiting at admission, pathway use, or laboratory testing including stool studies. However, after adjusting for covariates, Hispanic patients had more ultrasound scans performed (odds ratio 1.65, 95% confidence interval 1.04–2.64) and fewer orders for antiemetics (odds ratio 0.53, 95% CI 0.29–0.95) than non-Hispanic patients. CONCLUSIONS Although there were no differences in many aspects of AGE management between Hispanic and non-Hispanic patients, there was still variability in ultrasound scans performed and antiemetics ordered, despite similarities in reported abdominal pain, nausea, and vomiting. Prospective and/or qualitative studies may be needed to clarify underlying reasons for these differences.

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Racial/ethnic disparities in management of acute gastroenteritis in a pediatric emergency department

Cited by 3 publications

References 11 publications

Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals

Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals

Low‐value care in pediatric populations: There is no silver lining

Disparities in Management of Acute Gastroenteritis in Hospitalized Children

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