title: Racial/ethnic differences in the presentation and management of severe bronchiolitis.
abstract: OBJECTIVE
  Bronchiolitis is the leading cause of hospitalization for US infants and is associated with increased risk of childhood asthma. Although studies have shown differences in the presentation and management of asthma across race/ethnicity, it is unclear if such differences are present for bronchiolitis. We examined if racial/ethnic differences exist in the presentation and management of severe bronchiolitis.
  
  
  METHODS
  We performed a 16-center, prospective cohort study from 2007 to 2010. Children <2 years old 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 (eg, albuterol, corticosteroids, and continuous positive airway pressure/intubation), management (eg, intensive care unit admission and length of stay), discharge on inhaled corticosteroids, and bronchiolitis relapse.
  
  
  RESULTS
  Among 2130 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 (odds ratio [OR]: 1.58; 95% confidence interval [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).
  
  
  CONCLUSIONS
  We observed differences between NHW and minority children regarding preadmission 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 care pathways for severe bronchiolitis.
authors.affiliation: Yale, School of Medicine, New Haven, Connecticut.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Santiago
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Mansbach
authors.forename: Shih-Chuan
authors.initials: SC
authors.lastname: Chou
authors.forename: Carlos
authors.initials: C
authors.lastname: Delgado
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Piedra
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Janice A
authors.initials: JA
authors.lastname: Espinola
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D001741:Black or African American; D001988:Bronchiolitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000208:ethnology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data*; D011859:Radiography; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D001993:Bronchodilator Agents