Impact of patient race/ethnicity on emergency department management of pediatric gastroenteritis in the setting of a clinical pathway

Acad Emerg Med. 2021 Mar 20. doi: 10.1111/acem.14255. Online ahead of print.


BACKGROUND: Acute gastroenteritis (AGE) is a common pediatric diagnosis in emergency medicine, accounting for 1.7 million visits annually. Little is known about racial/ethnic differences in care in the setting of standardized care models.

METHODS: We used quality improvement data for children 6 months to 18 years presenting to a large, urban pediatric emergency department (ED) treated via a clinical pathway for AGE/dehydration between 2011 and 2018. Race/ethnicity was evaluated as a single variable (non-Hispanic [NH]-White, NH-Black, Hispanic, and NH-other) related to ondansetron and intravenous fluid (IVF) administration, ED length of stay (LOS), hospital admission, and ED revisits using multivariable regression.

RESULTS: Of 30,849 ED visits for AGE/dehydration, 18.0% were NH-White, 57.2% NH-Black, 12.5% Hispanic, and 12.3% NH-other. Multivariable mixed-effects generalized linear regression controlling for age, sex, triage acuity, payor, and language revealed that, compared to NH-White patients, NH-other patients were more likely to receive ondansetron (aOR [95% CI] 1.30 [1.17, 1.43]). NH-Black, Hispanic, and NH-other patients were significantly less likely to receive IVF (0.59 [0.53, 0.65]; 0.74 [0.64, 0.84]; 0.74 [0.65, 0.85]) or be admitted to the hospital (0.54 [0.45, 0.64]; 0.62 [0.49, 0.78]; 0.76 [0.61, 0.94]), respectively. NH-Black and Hispanic patients had shorter LOS (median 245 minutes for NH-White, 176 NH-Black, 199 Hispanic, and 203 NH-other patients) without significant differences in ED revisits.

CONCLUSIONS: Despite the presence of a clinical pathway to guide care, NH-Black, Hispanic, and NH-other children presenting to the ED with AGE/dehydration were less likely to receive IVF or hospital admission and had shorter LOS compared to NH-White counterparts. There was no difference in patient revisits which suggests discretionary overtreatment of NH-White patients, even with clinical guidelines in place. Further research is needed to understand the drivers of differences in care to develop interventions promoting equity in pediatric emergency care.

PMID:33745207 | DOI:10.1111/acem.14255