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.

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