Disparities in Management of Acute Gastroenteritis in Hospitalized Children
Michelle Polich1, Elizabeth Mannino-Avila1, Michelle Edmunds1
1Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California.
Insights
Hispanic children hospitalized with acute gastroenteritis (AGE) received fewer antiemetics and more ultrasounds than non-Hispanic children. This study highlights potential ethnic disparities in pediatric AGE management, warranting further investigation into care variations.
Area of Science:
- Pediatric Medicine
- Health Services Research
- Clinical Outcomes
Background:
- Acute gastroenteritis (AGE) is a leading cause of pediatric hospitalizations.
- Previous research indicates ethnic disparities in emergency department management of AGE.
- This study investigates management differences in hospitalized pediatric patients based on ethnicity.
Purpose of the Study:
- To evaluate medical management variations between Hispanic and non-Hispanic children hospitalized with AGE.
- To compare clinical pathway use, diagnostic testing, and interventions.
- To identify potential ethnic disparities in pediatric acute gastroenteritis care.
Main Methods:
- Retrospective single-center study of children (2 months to 12 years) admitted with AGE or related symptoms.
- Data collected from January 2016 to December 2020.
- Comparison of management between Hispanic and non-Hispanic patient groups.
Main Results:
- No significant differences in reported symptoms, pathway use, or laboratory testing.
- Hispanic patients underwent more ultrasound scans (OR 1.65).
- Hispanic patients received fewer antiemetic orders (OR 0.53).
Conclusions:
- Despite similarities in symptoms, ethnic variations exist in diagnostic imaging and antiemetic use for pediatric AGE.
- Further prospective or qualitative research is needed to understand the reasons for these observed differences.
- This study underscores the need to address potential disparities in managing acute gastroenteritis in children.
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.
Related Concept Videos
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:18Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...