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Racial, Ethnic Differences Found in Pediatric Antibiotic Prescribing at EDs

Antibiotics are prescribed to non-Latino white children seeking treatment for viral respiratory tract infections about twice as often in emergency departments (EDs) compared with non-Latino black children.

That’s according to a new study published in the journal Pediatrics, which suggests the practice is neither equitable nor particularly good medicine.

The multicenter study led by Children's National Health System researchers is the latest documentation of racial and ethnic differences in how acute respiratory tract infections are treated. Some past studies have looked at the primary care setting.

“It is encouraging that just 2.6%of children treated in pediatric Emergency Departments (EDs) across the nation received antibiotics for viral acute respiratory tract infections since antibiotics are ineffective in treating viral infections,” pointed out lead researcher Monica K. Goyal, MD. “However, it is troubling to see such persistent racial and ethnic differences in how medications are prescribed, in this case in the ED. In addition to providing the best evidence-based care, we also strive to provide equitable care to all patients.”

The study notes that antibiotics are inappropriately prescribed for 13% to 75% of pediatric patients presenting to EDs with acute respiratory tract infections. The condition commonly leads parents to seek emergency care for their children.

In conducting the retrospective cohort study, the study team analyzed deidentified electronic health data for the 2013 calendar year from seven geographically diverse pediatric EDs. The study ultimately involved 39,445 encounters for acute respiratory infections, with patients averaging 3.3 years old.

Results indicate that 4.3% of non-Latino white patients received oral, intravenous, or intramuscular antibiotics in the ED or upon discharge vs. 2.6% of Latino patients and 1.9% of non-Latino black patients.

“A number of studies have demonstrated disparities with regards to how children of different ethnicities and races are treated in our nation's pediatric EDs, including frequency of computed tomography scans for minor head trauma, laboratory and radiology tests, and pain management. Unfortunately, today's results provide further evidence of racial and ethnic differences in providing healthcare in the ED setting,” Goyal said. “Although, in this case, minority children received evidence-based care, more study is needed to explain why differences in care exist at all.”

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