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Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess
Dante J Nicotera1, Aseeyah A Islam1, Yupeng Liu1
1Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A.
Insights
Black children with retropharyngeal abscess (RPA) received less surgical care and had larger abscesses. These findings suggest healthcare disparities impacting pediatric RPA management and outcomes.
Area of Science:
- Otolaryngology
- Pediatric Health
- Health Equity
Background:
- Social determinants of health can influence otolaryngologic disease management and outcomes.
- Retropharyngeal abscess (RPA) is a serious condition in children requiring timely intervention.
Purpose of the Study:
- To investigate disparities in the presentation and outcomes of pediatric retropharyngeal abscess (RPA).
- To examine the association between social determinants of health, specifically area deprivation index (ADI), and RPA management.
Main Methods:
- Retrospective review of 231 pediatric patients with RPA from 2010 to 2021.
- Analysis of demographic data, clinical features, treatment decisions, and ADI scores.
- Statistical analyses including chi-square, t-tests, and regression to identify associations.
Main Results:
- Black patients were less likely to undergo surgery (53.2% vs. 71.6%) and received fewer pre-admission antibiotics (19.4% vs. 54.4%).
- Black patients who had surgery presented with larger abscesses (6.4 cm² vs. 3.8 cm²), had longer hospital stays (5.4 days vs. 3.2 days), and experienced delays in surgical intervention.
- Higher ADI scores correlated with an increased rate of trismus.
Conclusions:
- Disparities in access to primary care may lead to later disease presentation and increased medical management trials in Black pediatric patients with RPA.
- These findings highlight potential inequities in pediatric otolaryngologic care that warrant further investigation and intervention.
Objectives:
Differences in management and outcomes of otolaryngologic diseases may reflect inequities driven by social determinants of health. This study aimed to investigate disparities in presentation and outcomes of retropharyngeal abscess (RPA) among 231 pediatric patients.
Methods:
Medical records were searched for pediatric patients with RPA from 2010 to 2021. Charts were reviewed for demographics, clinical features, and treatment decisions. Area deprivation index (ADI) scores for patient zip codes were determined. Chi-square analysis independent samples t-test, and regression analyses were used to investigate associations between variables.
Results:
Among patients presenting for RPA, Black patients were less likely to undergo surgical management than non-Black patients (53.2% vs. 71.6%, p = 0.009). Black patients had a lower rate of treatment with antibiotics prior to hospital admission (19.4% vs. 54.4%, p < 0.001). Among patients who received surgery, Black patients had higher cross-sectional abscess area on CT (6.4 ± 8.4 cm2 > vs. 3.8 ± 3.3 cm2 , p = 0.014), longer length of stay (5.4 ± 3.3 days vs. 3.2 ± 1.5, p < 0.001), and longer time between admission and surgery (2.3 ± 2.1 vs. 0.83 ± 1.1, p < 0.001). Increased ADI was correlated with increased rate of trismus.
Conclusions:
Lower rates of pre-admission antibiotics and larger abscess area on CT imaging among Black patients may suggest disparities in access to primary care, resulting in presentation to tertiary care at later stages of disease and higher rates of medical management trial prior to surgical intervention.
Level Of Evidence:
3 (retrospective cohort study) Laryngoscope, 134:1907-1912, 2024.
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