Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Karen Jubanyik

Subject Area(s)

Medicine

Abstract

We examined if racial/ethnic differences exist in the presentation and management of severe bronchiolitis using a 16-center, prospective cohort study from 2007-2010. Children <2 years 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, management, discharge on inhaled corticosteroids, and bronchiolitis relapse. Among 2,130 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 (OR 1.58; 95%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 pre-admission 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 clinical care pathways for severe bronchiolitis.

Comments

This is an Open Access Thesis.

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