Reddy Pooja D, Raman Akshaya, Eljamri Soukaina, Shaffer Amber, Padia Reema
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Ann Otol Rhinol Laryngol. 2025 May;134(5):341-348. doi: 10.1177/00034894241310342. Epub 2025 Jan 2.
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.
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.
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.
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.
肉芽组织形成和气管炎是小儿气管切开术常见的并发症。环丙沙星/地塞米松是常用药物，但社会决定因素对该问题的影响尚未得到探讨。
本研究扩展了之前对一家学术机构2016年至2020年小儿气管切开术患者的队列研究。评估了健康的社会决定因素，包括种族、保险状况和居住特征，包括地区贫困指数（ADI）。采用逻辑回归、Wilcoxon秩和检验和对数秩检验（α = 0.05）分析这些决定因素与用药及气管切开术后结局之间的关系。
该队列包括182例患者；98/182（53.9%）为男性，140/182（76.9%）为非西班牙裔白人。非白人种族接受雾化环丙沙星/地塞米松的几率增加（OR = 2.80，95% CI = 1.25 - 6.29）。在有气管培养结果的患者中（n = 63），金黄色葡萄球菌在公共保险患者中更常见（29/47，7例为耐甲氧西林金黄色葡萄球菌，61.7%），而在私人保险患者中较少见（5/16，3例为耐甲氧西林金黄色葡萄球菌，31.3%；OR = 3.54，95% CI = 1.05 - 11.9）。7例肺炎链球菌患者的ADI更高（中位数 = 95，四分位间距 = 88 - 99），而无肺炎链球菌感染的患者ADI较低（中位数 = 77，四分位间距 = 65 - 81，P = 0.003）。与未发生气管炎的患者相比，发生气管炎的患者居住距离我们中心更远（中位数 = 44.7英里，四分位间距 = 27.7 - 91.4英里）（中位数 = 33.4英里，四分位间距 = 12.0 - 85.2英里，P = 0.02）。出院回家的儿童抗生素耐药性更普遍（14/35，40.0%），高于转至过渡性护理机构的儿童（3/28，10.7%；OR = 5.56，95% CI = 1.40 - 22.0），且与住院时间延长有关（中位数 = 70天，范围 = 34 - 152天，而中位数 = 35天，范围 = 15 - 75天，P = 0.02）。随着时间推移，非白人患者与白人患者相比脱管几率增加（HR = 2.85，95% CI = 1.21 - 6.70）。出院地点和ADI与气管切开术后敷料选择有关。
本研究揭示了环丙沙星/地塞米松使用方面的种族差异、气管培养结果与居住相关的差异以及与ADI相关的敷料选择，这突出了需要提供个性化、公平的护理以优化结局。
4级。
