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Disparities in Medication Prescriptions and Post-Tracheostomy Outcomes in Pediatric Patients

Pooja D Reddy1, Akshaya Raman1, Soukaina Eljamri1

  • 1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

The Annals of Otology, Rhinology, and Laryngology
|January 2, 2025
PubMed

Insights

Social determinants like race and insurance impact pediatric tracheostomy care, influencing antibiotic prescriptions and outcomes. Addressing these disparities is crucial for equitable and optimized patient care.

Area of Science:

  • Pediatric Otolaryngology
  • Health Services Research
  • Health Equity

Background:

  • Pediatric tracheostomy is associated with complications such as granulation tissue formation and tracheitis.
  • Ciprofloxacin/dexamethasone is a common treatment, but the role of social determinants of health (SDOH) in its prescription and patient outcomes is not well understood.

Purpose of the Study:

  • To investigate the influence of SDOH, including race, insurance status, and Area Deprivation Index (ADI), on the prescription of ciprofloxacin/dexamethasone and post-tracheostomy outcomes in pediatric patients.
  • To identify disparities in care and outcomes related to social factors.

Main Methods:

  • A retrospective cohort study of 182 pediatric tracheostomy patients (2016-2020) at a single academic institution.
  • Analysis of social determinants (race, insurance, ADI) and their association with medication prescriptions and outcomes using logistic regression, Wilcoxon rank-sum, and log-rank tests.

Main Results:

  • Non-White race was linked to increased odds of receiving nebulized ciprofloxacin/dexamethasone (OR=2.80).
  • Public insurance was associated with higher rates of Staphylococcus aureus (including MRSA) in tracheal cultures (OR=3.54).
  • Higher ADI correlated with Streptococcus pneumoniae presence and specific dressing choices. Tracheitis was associated with living further from the center, and antibiotic resistance was more prevalent in children discharged home, correlating with longer hospital stays. Non-White patients had higher decannulation odds (HR=2.85).

Conclusions:

  • Racial disparities exist in ciprofloxacin/dexamethasone use for pediatric tracheostomies.
  • Differences in tracheal culture results and dressing choices are associated with residence-related factors and ADI.
  • Tailored and equitable care strategies are necessary to optimize outcomes for all pediatric tracheostomy patients.
Abstract

Keywords:
ADIciprofloxacin/dexamethasonegranulation tissuepediatricsocial determinantstracheostomy

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