Title: Racial Disparity in Pediatric Radiography for Forearm Fractures
Country: United States
Age: Pediatric Only
Sex: All Sexes
Population: Multiple Groups
Care Setting: Inpatient and Outpatient
Clinical Setting: General Diagnostic Imaging
Data Level: Single Institution
Data Type: EHR
Data Source: Local data
Conclusion: Disparities In All Minority Groups
Health OutComes Reported: Yes
Free Text Conclusion: Both in ED and ambulatory service lines, non-White patients had significantly lower imaging rates than White patients. Non-Whites who were imaged in the ED had lower abnormal radiograph rates than Whites, thus had lower diagnostic yield.
Abstract: INTRODUCTION: The most common pediatric fractures involve the upper extremity. But there is limited study on racial disparity in diagnostic radiography for pediatric fractures. The literature has described the diagnostic accuracy of alternative diagnostic modalities with promising evidence of its ability to mitigate health inequity in primary care. Our objective was to understand if racial disparity exists in radiography for pediatric fractures. METHODS: In this four-year retrospective cohort study, we analyzed rates of radiographic imaging and abnormal radiograph detection in 4280 pediatric patients (ages 3-18 years) who presented with chief complaints of arm or wrist pain and trauma-related International Classification of Diseases 10th Revision (ICD-10) codes. We compared White children to all other races and stratified by emergency departments (ED) vs all other primary care ambulatory service lines. RESULTS: Non-White patients had lower imaging rate differences and lower odds receiving imaging in both ambulatory settings (0.65915, P=0.0162;-5.4%, P=0.0143) and in EDs (0.7732, P=0.0369; -4.7%, P=0.0368). Additionally, non-Whites in the ED had lower rates and lower odds of abnormal radiographs (-7.3%, P=0.0084; 0.6794, P=0.0089). CONCLUSION: Non-White patients seen in emergency and ambulatory settings had lower imaging rates for traumatic arm and wrist pain compared to White patients, indicating a healthcare disparity in pediatric imaging. Higher-level studies investigating the effect of social determinants of health, more detailed patient data, and provider bias on facture care equity are needed to understand underlying reasons for observed differences.