Examination of disparities in prehospital encounters for pediatric asthma exacerbations
Abstract Introduction There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pedia...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13042 |
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| author | Lauren Riney Sam Palmer Erik Finlay Andrew Bertrand Shannon Burcham Phyllis Hendry Manish Shah Kathryn Kothari David W. Ashby Daniel Ostermayer Olga Semenova Benjamin N. Abo Benjamin Abes Nichole Shimko Emily Myers Marshall Frank Tim Turner Mac Kemp Kim Landry Greg Roland Jennifer N. Fishe |
| author_facet | Lauren Riney Sam Palmer Erik Finlay Andrew Bertrand Shannon Burcham Phyllis Hendry Manish Shah Kathryn Kothari David W. Ashby Daniel Ostermayer Olga Semenova Benjamin N. Abo Benjamin Abes Nichole Shimko Emily Myers Marshall Frank Tim Turner Mac Kemp Kim Landry Greg Roland Jennifer N. Fishe |
| author_sort | Lauren Riney |
| collection | DOAJ |
| description | Abstract Introduction There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma. Methods This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2–18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations’ neighborhood‐based conditions and resources relevant to children using the Child Opportunity Index (COI) 2.0, and analyzed associations between EMS scene address COI with medications administered by EMS. Results A total of 765 patients had available racial data and 825 had scene addresses that were geocoded to a COI. EMS administered at least 1 bronchodilator to 84.7% (n = 492) of non‐White patients and 83.2% of White patients (n = 153), P = 0.6. EMS administered a systemic corticosteroid to 19.4% (n = 113) of non‐White patients and 20.1% (n = 37) of White patients, P = 0.8. There was a significant difference in bronchodilator administration between COI categories of low/very low versus moderate/high/very high (85.0%, n = 485 vs. 75.9%, n = 192, respectively, P = 0.003). Conclusions There were no racial differences in EMS administration of medications to pediatric asthma patients. However, there were significantly higher rates of EMS bronchodilator administration for encounters in low/very low COIs. That latter finding may reflect inequities in asthma exacerbation severity for patients living in disadvantaged areas. |
| format | Article |
| id | doaj-art-5dd632d38b3f4401ac659c779ecb53c2 |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-5dd632d38b3f4401ac659c779ecb53c22025-08-20T03:34:44ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-10-0145n/an/a10.1002/emp2.13042Examination of disparities in prehospital encounters for pediatric asthma exacerbationsLauren Riney0Sam Palmer1Erik Finlay2Andrew Bertrand3Shannon Burcham4Phyllis Hendry5Manish Shah6Kathryn Kothari7David W. Ashby8Daniel Ostermayer9Olga Semenova10Benjamin N. Abo11Benjamin Abes12Nichole Shimko13Emily Myers14Marshall Frank15Tim Turner16Mac Kemp17Kim Landry18Greg Roland19Jennifer N. Fishe20Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati Ohio USACollege of Design, Construction, and Planning University of Florida GeoPlan Center Gainesville Florida USACollege of Design, Construction, and Planning University of Florida GeoPlan Center Gainesville Florida USADepartment of Emergency Medicine University of Florida College of Medicine Jacksonville Florida USADepartment of Pediatrics University of Florida College of Medicine Gainesville Florida USADepartment of Emergency Medicine University of Florida College of Medicine Jacksonville Florida USABaylor College of Medicine Texas Children's Hospital Houston Texas USABaylor College of Medicine Texas Children's Hospital Houston Texas USABaylor College of Medicine Texas Children's Hospital Houston Texas USAMcGovern Medical School University of Texas Health Houston Texas USACincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati Ohio USALee County Emergency Medical Services Fort Myers Florida USALee County Emergency Medical Services Fort Myers Florida USAGolisano Children's Hospital of Southwest Florida Fort Myers Florida USASarasota County Fire Department Sarasota Florida USADepartment of Emergency Medicine Florida State University College of Medicine Tallahassee Florida USAWalton County Fire Rescue Department Defuniak Springs Florida USALeon County EMS Tallahassee Florida USALeon County EMS Tallahassee Florida USANassau County Fire Department Yulee Florida USADepartment of Emergency Medicine University of Florida College of Medicine Jacksonville Florida USAAbstract Introduction There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma. Methods This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2–18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations’ neighborhood‐based conditions and resources relevant to children using the Child Opportunity Index (COI) 2.0, and analyzed associations between EMS scene address COI with medications administered by EMS. Results A total of 765 patients had available racial data and 825 had scene addresses that were geocoded to a COI. EMS administered at least 1 bronchodilator to 84.7% (n = 492) of non‐White patients and 83.2% of White patients (n = 153), P = 0.6. EMS administered a systemic corticosteroid to 19.4% (n = 113) of non‐White patients and 20.1% (n = 37) of White patients, P = 0.8. There was a significant difference in bronchodilator administration between COI categories of low/very low versus moderate/high/very high (85.0%, n = 485 vs. 75.9%, n = 192, respectively, P = 0.003). Conclusions There were no racial differences in EMS administration of medications to pediatric asthma patients. However, there were significantly higher rates of EMS bronchodilator administration for encounters in low/very low COIs. That latter finding may reflect inequities in asthma exacerbation severity for patients living in disadvantaged areas.https://doi.org/10.1002/emp2.13042asthmaChild Opportunity Indexemergency medical serviceshealth disparitiespediatric |
| spellingShingle | Lauren Riney Sam Palmer Erik Finlay Andrew Bertrand Shannon Burcham Phyllis Hendry Manish Shah Kathryn Kothari David W. Ashby Daniel Ostermayer Olga Semenova Benjamin N. Abo Benjamin Abes Nichole Shimko Emily Myers Marshall Frank Tim Turner Mac Kemp Kim Landry Greg Roland Jennifer N. Fishe Examination of disparities in prehospital encounters for pediatric asthma exacerbations Journal of the American College of Emergency Physicians Open asthma Child Opportunity Index emergency medical services health disparities pediatric |
| title | Examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| title_full | Examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| title_fullStr | Examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| title_full_unstemmed | Examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| title_short | Examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| title_sort | examination of disparities in prehospital encounters for pediatric asthma exacerbations |
| topic | asthma Child Opportunity Index emergency medical services health disparities pediatric |
| url | https://doi.org/10.1002/emp2.13042 |
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