Racial/Ethnic differences in the presentation and management of severe bronchiolitis
- 10 June 2014
- journal article
- research article
- Published by Wiley in Journal of Hospital Medicine
- Vol. 9 (9), 565-572
- https://doi.org/10.1002/jhm.2223
Abstract
Bronchiolitis is the leading cause of hospitalization for US infants and is associated with increased risk of childhood asthma. Although studies have shown differences in the presentation and management of asthma across race/ethnicity, it is unclear if such differences are present for bronchiolitis. We examined if racial/ethnic differences exist in the presentation and management of severe bronchiolitis. We performed a 16-center, prospective cohort study from 2007 to 2010. Children <2 years old hospitalized with a diagnosis of bronchiolitis were included. A structured interview, chart review, and 1-week phone follow-up were completed. Multivariable logistic regression was used to examine the independent association between race/ethnicity and diagnostic imaging, treatment (eg, albuterol, corticosteroids, and continuous positive airway pressure/intubation), management (eg, intensive care unit admission and length of stay), discharge on inhaled corticosteroids, and bronchiolitis relapse. Among 2130 patients, 818 (38%) were non-Hispanic white (NHW), 511 (24%) were non-Hispanic black (NHB), and 801 (38%) were Hispanic. Compared with all groups, NHB children were most likely to receive albuterol before admission (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.20-2.07) and least likely to receive chest x-rays during hospitalization (OR: 0.66; 95% CI: 0.49-0.90). Hispanic children were most likely to be discharged on inhaled corticosteroids (OR: 1.92; 95% CI: 1.19-3.10). We observed differences between NHW and minority children regarding preadmission albuterol use, inpatient diagnostic imaging, and prescription of inhaled corticosteroids at discharge, practices that deviate from the American Academy of Pediatrics guidelines. The causes of these differences require further study, but they support implementation of care pathways for severe bronchiolitis.Keywords
Funding Information
- National Institutes of Health (U01 AI-67693)
This publication has 33 references indexed in Scilit:
- Trends in Bronchiolitis Hospitalizations in the United States, 2000–2009Published by American Academy of Pediatrics (AAP) ,2013
- Infectious Disease Hospitalizations Among Infants in the United StatesPediatrics, 2008
- US Outpatient Office Visits for Bronchiolitis, 1993–2004Academic Pediatrics, 2007
- Direct Medical Costs of Bronchiolitis Hospitalizations in the United StatesPEDIATRICS, 2006
- Diagnosis and Management of BronchiolitisPEDIATRICS, 2006
- Bronchiolitis in US Emergency Departments 1992 to 2000Pediatric Emergency Care, 2005
- Effect of Practice Variation on Resource Utilization in Infants Hospitalized for Viral Lower Respiratory IllnessPediatrics, 2001
- Rates of hospitalization for respiratory syncytial virus infection among children in MedicaidThe Journal of Pediatrics, 2000
- Study of interobserver reliability in clinical assessment of RSV lower respiratory illness: A pediatric investigators collaborative network for infections in Canada (PICNIC) studyPediatric Pulmonology, 1996
- Respiratory syncytial virusCurrent Problems in Pediatrics, 1993