Study suggests white children are more likely than black and Hispanic children to receive intravenous fluids and be admitted to the hospital for dehydration caused by common childhood illness.
NEW ORLEANS, La.—New research being presented at the American Academy of Pediatrics 2019 National Conference & Exhibition suggests that the treatment children receive in U.S. emergency departments for acute gastroenteritis with dehydration, a common childhood illness, may differ based on their race.
The study abstract, “Impact of patient race/ethnicity on emergency department management of gastroenteritis,” will be presented on Monday, Oct. 28, at the Ernest N. Morial Convention Center in New Orleans.
Acute gastroenteritis is a sudden inflammation of the digestive tract, often caused by a virus, bacteria or other pathogen, with symptoms such as diarrhea, vomiting and fever that can quickly lead to dehydration. The condition accounts for more than 1.7 million outpatient visits and nearly 300 deaths each year among U.S. children.
“Children with acute gastroenteritis sometimes have trouble replacing the fluids and electrolytes their bodies are losing, which makes prompt treatment important,” said abstract author Morgan Congdon, MD, MPH, a pediatric hospitalist at Children’s Hospital of Philadelphia. “However, we found that race and ethnicity may play a role in the type of care and treatment children receive in emergency departments.”
For the study, the research team performed a retrospective analysis of patients aged 6 months to 18 years seen between January 2011 and October 2018 in a large, urban pediatric emergency department for acute gastroenteritis with dehydration.
The researchers evaluated clinical outcomes such as whether the children were given an anti-nausea drug or intravenous fluids, as well as how long the children stayed in the emergency department and whether they were admitted to the hospital.
Of the 30,849 patients seen for acute gastroenteritis with dehydration, 57.2% were non-Hispanic black, 17.9% were non-Hispanic white, 12.5% were Hispanic, and 12.3% were other races. Adjusting for age, gender, language, insurance, and how sick a child was at presentation using triage acuity rating, researchers found that non-Hispanic black, Hispanic, and other race patients were significantly less likely to receive intravenous fluids and be admitted to the hospital than white patients. Non-Hispanic black and Hispanic patients also had shorter emergency department length of stay. Other race patients were more likely to receive the anti-nausea drug ondansetron than non-Hispanic white patients, but no significant differences were observed for non-Hispanic back and Hispanic patients.
The researchers said there were no significant racial/ethnic differences in 72-hour revisits to the emergency department, however, which may suggest possible discretionary overtreatment in white patients as opposed to undertreatment in non-white patients.
“This study is important because it highlights a growing body of evidence that children do not always receive equal health care in the emergency department based on the child’s race or ethnicity,” Dr. Congdon said. She said further research is needed to understand the drivers of these racial and ethnic differences and develop ways to address them.
“I hope that this work will contribute to efforts to develop interventions that can support physicians and healthcare workers to create a more equitable system,” Dr. Congdon said.
Dr. Congdon will present an abstract of the study, available below, at 11:30 a.m. Oct. 28 in rooms 388-90 in the Ernest N. Morial Convention Center. To request an interview with Dr. Congdon, journalists may contact AAP media relations or Children’s Hospital of Philadelphia media relations officer Natalie Solimeo at solimeon@email.chop.edu.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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Abstract Title: Impact of patient race/ethnicity on emergency department management of gastroenteritis
Presenting author: Morgan Congdon, MD, MPH
Background: Acute gastroenteritis (AGE) is a common emergency department (ED) presentation in pediatric patients, accounting for greater than 1.7 million outpatient visits and nearly 300 deaths yearly. Although disparities in pediatric ED care have been widely reported, little is known about racial differences in the quality of care for pediatric AGE.
Objective: To determine if racial/ethnic differences exist in the ED management of AGE with dehydration.
Methods: We performed a retrospective analysis of patients aged 6 months-18 years who presented to a large, urban pediatric ED between 1/22/11- 10/24/18 with AGE/dehydration using quality improvement (QI) data from an AGE pathway created in 2007. Based on the QI pathway criteria, we excluded higher acuity patients (triage acuity 1 and 2). Outcomes included ondansetron use, intravenous fluid (IVF) administration, ED length of stay (LOS), hospital admission, and 72-hour ED revisits, which were evaluated using multivariate regression models.
Results: Of 30,849 patients who met the inclusion criteria with visits for AGE/dehydration, 57.2% were non-Hispanic (NH) Black, 17.9% NH White, 12.5% Hispanic, and 12.3% Other races. Multivariate analysis adjusting for age, gender, language, insurance, and triage acuity revealed that, compared to White patients, NH Black, Hispanic, and Other race patients were significantly less likely to receive IVF (aOR [95% CI]= 0.60 [0.55, 0.67]; 0.76 [0.67, 0.87]; and 0.77 [0.67, 0.87] respectively) and be admitted to the hospital (0.61 [0.55, 0.67]; 0.75 [0.66, 0.86]; and 0.76 [0.67, 0.86]). NH Black and Hispanic patients also had shorter LOS (Coef., 95% CI= -20.3 [-24.9, -15.7] and -10.8 [-16.7, -4.9] respectively). Other race patients were more likely to receive ondansetron than NH White patients (aOR 1.26 [1.15, 1.38]), but no significant differences were observed for NH Black and Hispanic patients. There were no significant racial/ethnic differences in 72-hour revisits.
Conclusion: This study demonstrates that non-White children presenting to the ED with AGE/dehydration are less likely to receive IVF or be admitted to the hospital and have shorter ED LOS. We found no difference in ED revisits, suggesting possible discretionary overtreatment in White patients as opposed to undertreatment in non-White patients. Further research is needed to understand the drivers of these differences and develop interventions to improve equity in pediatric ED care.