Racial and Ethnic Disparities in Length of Stay for Pediatric Bacterial Tracheostomy-Associated Infections

BACKGROUND AND OBJECTIVES: Racial and ethnic disparities disproportionately impact children with medical complexity (CMC), including children with tracheostomies. Children hospitalized for bacterial tracheostomy-associated infections (bTRAINs) experience care variations that may exacerbate disparities. Our study aimed to quantify disparities in length of stay (LOS) for children hospitalized with bTRAINs. METHODS: We conducted a multicenter observational study of children aged 0 to 21 years who were hospitalized and treated for a bTRAIN at 6 children's hospitals between August 2020 and August 2024, excluding children with outlier LOS (>30 days). Our primary predictor was race and ethnicity, as documented in the electronic medical record. Our primary outcome was LOS (days). We used mixed-effects regression modeling to account for repeated encounters, nesting of patients within hospitals, and adjusting for confounders (socioeconomic factors, comorbidities and illness severity). RESULTS: We included 662 children (39% white, 35% Hispanic, 22% Black, and 4% Asian) representing 1349 unique encounters. The median age at hospitalization was 6 years (IQR 2-13) and 72% of children had public insurance. Median LOS was 8 days (IQR 5-12). When adjusting for confounders, all other racial groups had longer LOS compared with white children with ratio of means of 1.14 (95% CI: 1.03-1.28) for Black; 1.12 (95% CI: 1.01-1.25) for Hispanic; and 1.29 (95% CI: 1.07-1.54) for Asian children. CONCLUSIONS: Black, Hispanic, and Asian children hospitalized for a bTRAIN experience longer LOS than white children. Understanding is needed on how implicit bias, systemic racism, and care-team preferences lead to disparities and if standardized care can improve outcomes.