157 - Disparities in Hospital Admissions and Diagnostic Testing by Patient Race, Ethnicity, and Language in the Pediatric ED.

Poster Number: 157
Publication Number: 157.411

Cassandra Koid Jia Shin, Seattle Children's, SEATTLE, WA, United States; Erin Sullivan, Seattle Children's, Seattle, WA, United States; Etiowo N. Usoro, Seattle Children's, Seattle, WA, United States; Brian Burns, Seattle Children's Hospital, Seattle, WA, United States; Emily A. Hartford, University of Washington School of Medicine, Seattle, WA, United States

Background: Disparities for patients of different racial/ethnic backgrounds exist in the pediatric emergency department (ED), such as lower acuity scores and longer wait times for non-Hispanic Black (NHB) and Hispanic patients when compared to non-Hispanic white (NHW) patients. There are also differences by race, ethnicity, and language preference (REAL) in the use of diagnostics, rates of admission, and adherence to evidence-based guidelines.

Objective: To analyze the relationship between REAL and ED wait times, diagnostic evaluation, length of stay, disposition, and return visits, accounting for differences in ED triage scores.

Design/Methods: This was a retrospective cohort study of patient encounters from 1/1-12/31, 2019 in a high volume academic pediatric ED. Inclusion criteria were all encounters for patients 0-21 years; mental health visits were excluded. Patient’s race, ethnicity, and language preference were self-reported. Patient demographics were summarized descriptively by ESI. Logistic regression assessed the association between REAL and patient outcomes controlling for known confounders (ESI, insurance, medical complexity). Heat maps were created to show the use of diagnostics for common conditions stratified by ESI and REAL. This study was approved by the IRB.

Results: A total of 47,995 patient encounters were analyzed. When compared to NHW patients, patients who were NHB (0.68; 95% CI: 0.61-0.77), Hispanic (0.92; 95% CI: 0.84-1.01), Asian (0.89; 95% CI 0.80-1.00), and other (Native Hawaiian/Pacific Islander, American Indian/Alaska Native, or > 2 races) (0.91; 95% CI 0.82-1.00) had lower odds ratios of being admitted to the hospital after adjusting for ESI, complexity, and insurance status (Table 2). Patients who spoke a language other than English (0.91; 95% CI: 0.82-1.01) showed a trend towards lower admissions but did not reach significance. There were no significant differences in times to provider, length of stay, or return visits by REAL in the adjusted models. In patients with upper respiratory infections (URI) and a moderate/low acuity ESI, NHW patients received more imaging (24.8% vs 20.1% or 19.1%) than Hispanic and NHB patients, although imaging seemed to be related to ESI level. NHW patients with asthma had more imaging than any other patient group (22.7% vs 14.1% - Hispanic, 18.5% - NHB and 15.4% - Asian).Conclusion(s): Patients who identified as Hispanic, NHB, Asian, and other were significantly less likely to be admitted to the hospital from our pediatric ED when compared to NHW patients. This and disparities in the use of diagnostics will be the focus of future work to improve equity.
Cassandra Koid CVCK UW CV 2021-2022.pdf
Table 1. Demographics of the Population by ESI at TriagePatient demographics were summarized descriptively by ESI for race, ethnicity, language, and patient care outcomes.