Disparities in Medication Prescriptions and Post-Tracheostomy Outcomes in Pediatric Patients.

BACKGROUND

Granulation tissue formation and tracheitis are common pediatric tracheostomy complications. Ciprofloxacin/dexamethasone is frequently prescribed, but the influence of social determinants on this topic is unexplored.

METHODS

This study extends a prior cohort study of pediatric tracheostomy patients at a single academic institution from 2016 to 2020. Social determinants of health, including race, insurance status, and residence characteristics, including Area Deprivation Index (ADI), were evaluated. Logistic regression, Wilcoxon rank-sum, and log-rank tests (α = .05) analyzed relationships between these determinants and prescriptions and post-tracheostomy outcomes.

RESULTS

This cohort included 182 patients; 98/182 (53.9%) were male, and 140/182 (76.9%) were White, non-Hispanic. Non-White race was associated with increased odds of receiving nebulized ciprofloxacin/dexamethasone (OR = 2.80, 95% CI = 1.25-6.29). In those with tracheal culture results available (n = 63), Staphylococcus aureus was more common with public insurance (29/47, 7 with MRSA, 61.7%) compared with private (5/16, 3 with MRSA, 31.3%; OR = 3.54, 95% CI = 1.05-11.9). ADI was greater in the 7 patients with Streptococcus pneumoniae (median = 95, IQR = 88-99) compared to without (median = 77, IQR = 65-81,  = .003). Patients with tracheitis lived further from our center (median = 44.7 miles, IQR = 27.7-91.4 miles) compared with those who did not develop tracheitis (median = 33.4 miles, IQR = 12.0-85.2 miles,  = .02). Antibiotic resistance was more prevalent in children discharged home (14/35, 40.0%) than to transitional care (3/28, 10.7%; OR = 5.56, 95% CI = 1.40-22.0) and was associated with longer hospital stays (median = 70 days, range = 34-152 vs median = 35 days, range = 15-75 days,  = .02). Non-White patients experience increased odds of decannulation over time compared with White patients (HR = 2.85, 95% CI = 1.21-6.70). Discharge locations and ADI were associated with dressing choice post-tracheostomy.

DISCUSSION

This study revealed racial disparities in ciprofloxacin/dexamethasone usage, residence-related differences in tracheal culture results, and ADI-related dressing choices, which highlight the need for tailored, equitable care to optimize outcomes.

LEVEL OF EVIDENCE