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Racial and Ethnic Disparities in Length of Stay for Pediatric Bacterial Tracheostomy-Associated Infections

Margaret Rush1,2, Ilana Moffet3, Naoko Kono4

  • 1Division of Hospital Medicine, Children's National Hospital Washington, District of Columbia.

Hospital Pediatrics
|July 15, 2026
PubMed

Insights

Children from racial and ethnic minority groups hospitalized for bacterial tracheostomy-associated infections (bTRAINs) experienced longer hospital stays. This highlights significant racial disparities in healthcare for children with complex medical needs.

Area of Science:

  • Pediatric hospital medicine
  • Health services research
  • Health equity

Background:

  • Racial and ethnic disparities disproportionately affect children with medical complexity (CMC).
  • Children with tracheostomies are a vulnerable CMC population.
  • Bacterial tracheostomy-associated infections (bTRAINs) can lead to prolonged hospitalizations and expose children to care variations.

Purpose of the Study:

  • To quantify racial and ethnic disparities in length of stay (LOS) for children hospitalized with bTRAINs.
  • To identify if specific racial or ethnic groups experience longer hospitalizations for bTRAINs.
  • To provide data for interventions aimed at reducing healthcare disparities in pediatric care.

Main Methods:

  • Multicenter observational study of children (0-21 years) hospitalized for bTRAINs across 6 children's hospitals.
  • Analysis of 1349 unique encounters from August 2020 to August 2024, excluding outlier LOS (>30 days).
  • Mixed-effects regression modeling adjusted for socioeconomic factors, comorbidities, and illness severity to compare LOS across racial groups.

Main Results:

  • The study included 662 children, with 39% White, 35% Hispanic, 22% Black, and 4% Asian.
  • Median LOS was 8 days; however, adjusted analyses revealed significantly longer LOS for Black (1.14), Hispanic (1.12), and Asian (1.29) children compared to White children.
  • These disparities persisted after controlling for socioeconomic factors, comorbidities, and illness severity.

Conclusions:

  • Black, Hispanic, and Asian children hospitalized for bTRAINs experience longer LOS than their White counterparts.
  • Further research is needed to understand the roles of implicit bias, systemic racism, and care-team preferences in these disparities.
  • Standardized care protocols may be crucial for improving outcomes and reducing disparities in this population.
Abstract

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