Disparities in Management of Acute Gastroenteritis in Hospitalized Children

Hosp Pediatr. 2023 Dec 1;13(12):1106-1114. doi: 10.1542/hpeds.2023-007283.

Abstract

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.

MeSH terms

  • Antiemetics* / therapeutic use
  • Child
  • Child, Hospitalized
  • Emergency Service, Hospital
  • Female
  • Gastroenteritis* / diagnosis
  • Gastroenteritis* / therapy
  • Humans
  • Infant, Newborn
  • Male
  • Nausea / drug therapy
  • Prospective Studies
  • Retrospective Studies
  • Vomiting / drug therapy
  • Vomiting / etiology

Substances

  • Antiemetics