Meeting NewsPerspective

Kids’ treatment for acute gastroenteritis in ED depends on race, study shows

NEW ORLEANS — Children with acute gastroenteritis with dehydration receive unequal treatment in the ED because of race, according to a retrospective analysis of more than 30,000 patients.

“Children with acute gastroenteritis sometimes have trouble replacing the fluids and electrolytes their bodies are losing, which makes prompt treatment important,” Morgan Congdon, MD, MPH, a pediatric hospitalist at Children's Hospital of Philadelphia, said in a press release. "However, we found that race and ethnicity may play a role in the type of care and treatment children receive in emergency departments.

Acute gastroenteritis is common in children, accounting for more than 1.7 million outpatient visits and nearly 300 deaths each year in the United States, according to researchers.

Congdon and colleagues evaluated the clinical outcomes and treatment of children aged 6 months to 18 years who presented to a large, urban pediatric ED for acute gastroenteritis with dehydration between January 2011 and October 2018.

Of the 30,849 patients included in the analysis, 57.2% were non-Hispanic black, 17.9% were non-Hispanic white, 12.5% were Hispanic, and 12.3% were of other races. After adjusting for factors like age, gender, language, insurance and how sick a child was at presentation, the researchers found that non-Hispanic black, Hispanic and patients of other races were significantly less likely to receive IV fluids (aOR = 0.6; 95% CI, 0.55-0.67; aOR = 0.76; 95% CI, 0.67-0.87; and aOR = 0.77; 95% CI, 0.67-0.87, respectively) and be admitted to the hospital (aOR = 0.61; 95% CI, 0.55-0.67; aOR = 0.75; 95% CI, 0.66-0.86; and aOR = 0.76; 95% CI, 0.67-0.86, respectively) than white patients.

The study also showed that non-Hispanic black and Hispanic patients had shorter ED lengths of stay (coefficient = –20.3; 95% CI, –24.9 to –15.7 and coefficient = –10.8; 95% CI, –16.7 to –4.9, respectively). Patients of other races were more likely to receive the anti-nausea drug ondansetron than non-Hispanic white patients (aOR = 1.26; 95% CI, 1.15-1.38), but there were no significant differences for non-Hispanic black and Hispanic patients.

The researchers said they found no difference in the rates of revisits to the ED within 72 hours, suggesting that physicians are overtreating white children, rather than undertreating nonwhite children.

"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," Congdon said. "I hope that this work will contribute to efforts to develop interventions that can support physicians and health care workers to create a more equitable system." – by John Schoen

Reference:

Congdon M, et al. Impact of patient race/ethnicity on emergency department management of gastroenteritis. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosure: Infectious Diseases in Children was unable to confirm Congdon’s relevant financial disclosures at the time of publication.

NEW ORLEANS — Children with acute gastroenteritis with dehydration receive unequal treatment in the ED because of race, according to a retrospective analysis of more than 30,000 patients.

“Children with acute gastroenteritis sometimes have trouble replacing the fluids and electrolytes their bodies are losing, which makes prompt treatment important,” Morgan Congdon, MD, MPH, a pediatric hospitalist at Children's Hospital of Philadelphia, said in a press release. "However, we found that race and ethnicity may play a role in the type of care and treatment children receive in emergency departments.

Acute gastroenteritis is common in children, accounting for more than 1.7 million outpatient visits and nearly 300 deaths each year in the United States, according to researchers.

Congdon and colleagues evaluated the clinical outcomes and treatment of children aged 6 months to 18 years who presented to a large, urban pediatric ED for acute gastroenteritis with dehydration between January 2011 and October 2018.

Of the 30,849 patients included in the analysis, 57.2% were non-Hispanic black, 17.9% were non-Hispanic white, 12.5% were Hispanic, and 12.3% were of other races. After adjusting for factors like age, gender, language, insurance and how sick a child was at presentation, the researchers found that non-Hispanic black, Hispanic and patients of other races were significantly less likely to receive IV fluids (aOR = 0.6; 95% CI, 0.55-0.67; aOR = 0.76; 95% CI, 0.67-0.87; and aOR = 0.77; 95% CI, 0.67-0.87, respectively) and be admitted to the hospital (aOR = 0.61; 95% CI, 0.55-0.67; aOR = 0.75; 95% CI, 0.66-0.86; and aOR = 0.76; 95% CI, 0.67-0.86, respectively) than white patients.

The study also showed that non-Hispanic black and Hispanic patients had shorter ED lengths of stay (coefficient = –20.3; 95% CI, –24.9 to –15.7 and coefficient = –10.8; 95% CI, –16.7 to –4.9, respectively). Patients of other races were more likely to receive the anti-nausea drug ondansetron than non-Hispanic white patients (aOR = 1.26; 95% CI, 1.15-1.38), but there were no significant differences for non-Hispanic black and Hispanic patients.

The researchers said they found no difference in the rates of revisits to the ED within 72 hours, suggesting that physicians are overtreating white children, rather than undertreating nonwhite children.

"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," Congdon said. "I hope that this work will contribute to efforts to develop interventions that can support physicians and health care workers to create a more equitable system." – by John Schoen

Reference:

Congdon M, et al. Impact of patient race/ethnicity on emergency department management of gastroenteritis. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosure: Infectious Diseases in Children was unable to confirm Congdon’s relevant financial disclosures at the time of publication.

    Perspective
    George J. Fuchs

    George J. Fuchs

    The study showed the difference between two groups, and the researchers did control for certain variables, including insurance type, which is a proxy for socioeconomic status — it’s imperfect, but it’s reasonable. One thing I did not see that they controlled for was the educational level of the parents.

    The bottom line is that the nonminority population received more aggressive treatment. Because they did follow up, the researchers were able to see that the outcomes weren’t different. One of their conclusions, which I agree with, is that the nonminority population got more aggressive treatment than was necessary — it wasn’t that the minority population didn’t get adequate treatment. 

    I would be speculating, but there could be some inherent racial bias at work. The reason I’d be interested in looking at the educational level of the parents is that when providers interact with parents, they can relate to them if they are more articulate or seem more knowledgeable about the health care system, and they might be a little more aggressive with treatment.

    • George J. Fuchs, MD
    • Professor and vice chair of pediatrics
      Chief, pediatric gastroenterology, hepatology and nutrition
      University of Kentucky Healthcare

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