Disparities in Admission and Pediatric Emergency Outcomes by Race, Ethnicity, and Language.

Abstract

Background and Objectives: Disparities by race, ethnicity, and language (REaL) in the pediatric emergency department (ED) include differences in triage acuity scores, wait times, diagnostic testing and imaging, pain management, and admission. The primary aim of this study was to analyze the relationship between REaL and core ED quality of care outcomes in an academic pediatric ED including wait time, length of stay, disposition, and return visits. Methods: This was a retrospective cohort study from January 1-December 31, 2019, at a freestanding pediatric ED of patients 0-21 years. Patients’ race, ethnicity, and language preference were self-reported and the main outcomes were admission to the hospital, LOS, wait times, and unexpected return ED visits. Generalized estimating equations (GEE) and Cox proportional hazard models were used to assess the association between REaL and patient outcomes. Results: 35,180 patient encounters were analyzed. White patients had significantly higher adjusted odds of hospital admission while Black patients had significantly lower adjusted odds of admission compared to the overall population means. Hispanic patients and patients with a language other than English are seen by providers at a slower rate and Asian patients were discharged from the ED at a slightly faster than average rate. Conclusions: There were differences by patient race, ethnicity, and language for care in the likelihood of hospital admission, wait times, and length of stay. These findings will be incorporated into ongoing work to improve equity in our ED.