Impact of patient race/ethnicity on emergency department management of pediatric gastroenteritis in the setting of a clinical pathway

Background Acute gastroenteritis (AGE) is a common pediatric diagnosis in emergency medicine, accounting for 1.7 million visits annually. Little is known about racial/ethnic differences in care in the setting of standardized care models. Methods We used quality improvement data for children 6 months to 18 years presenting to a large, urban pediatric emergency department (ED) treated via a clinical pathway for AGE/dehydration between 2011 and 2018. Race/ethnicity was evaluated as a single variable (non‐Hispanic [NH]‐White, NH‐Black, Hispanic, and NH‐other) related to ondansetron and intravenous fluid (IVF) administration, ED length of stay (LOS), hospital admission, and ED revisits using multivariable regression. Results Of 30,849 ED visits for AGE/dehydration, 18.0% were NH‐White, 57.2% NH‐Black, 12.5% Hispanic, and 12.3% NH‐other. Multivariable mixed‐effects generalized linear regression controlling for age, sex, triage acuity, payer, and language revealed that, compared to NH‐White patients, NH‐other patients were more likely to receive ondansetron (adjusted odds ratio [95% CI] = 1.30 [1.17 to 1.43]). NH‐Black, Hispanic, and NH‐other patients were significantly less likely to receive IVF (0.59 [0.53 to 0.65]; 0.74 [0.64 to 0.84]; 0.74 [0.65 to 0.85]) or be admitted to the hospital (0.54 [0.45 to 0.64]; 0.62 [0.49 to 0.78]; 0.76 [0.61 to 0.94]), respectively. NH‐Black and Hispanic patients had shorter LOS (median = 245 minutes for NH‐White, 176 NH‐Black, 199 Hispanic, and 203 NH‐other patients) without significant differences in ED revisits. Conclusions Despite the presence of a clinical pathway to guide care, NH‐Black, Hispanic, and NH‐other children presenting to the ED with AGE/dehydration were less likely to receive IVF or hospital admission and had shorter LOS compared to NH‐White counterparts. There was no difference in patient revisits, which suggests discretionary overtreatment of NH‐White patients, even with clinical guidelines in place. Further research is needed to understand the drivers of differences in care to develop interventions promoting equity in pediatric emergency care.