Payne 2013


Year: 2013

Title: Racial Disparities in Ordering Laboratory and Radiology Tests for Pediatric Patients in the Emergency Department

Country: United States

Age: Pediatric Only

Sex: All Sexes

Population: Multiple Groups

Care Setting: Emergency Department

Clinical Setting: General Diagnostic Imaging

Data Level: Multi-Institution

Data Type: EHR

Data Source: Local data

Conclusion: Disparities In All Minority Groups

Health OutComes Reported: No

Mitigation: No

Free Text Conclusion: Minority pediatric patients in the ED less likely to get imaging of any kind even in controlled model.

Abstract: Objective: The objective of this study was to examine the association of race and language on laboratory and radiological testing in the pediatric emergency department (ED). Methods: This retrospective, case-cohort study examined laboratory and radiological testing among patients discharged home from 2 urban, pediatric EDs between March 2, 2009, and March 31, 2010. Results: There were 75,254 visits among 49,164 unique patients, of whom 31.0% had laboratory and 30.5% had radiological testing. African American (adjusted odds ratio [aOR], 0.93; confidence interval [CI], 0.89-0.98; P = 0.004) and biracial racial categories (aOR, 0.91; CI, 0.86-0.98; P = 0.007) were associated with decreased odds of laboratory testing compared with non-Hispanic whites. Similarly, Native American (aOR, 0.82; CI, 0.73-0.94), African American (aOR0.81; CI, 0.72-0.81), biracial (aOR, 0.82; CI, 0.77-0.88), Hispanic (aOR.76; CI, 0.72-0.81), and "other" (aOR, 0.84; CI, 0.73-0.97) racial categories were each associated with lower odds of radiological testing compared with non-Hispanic whites. Subgroup analysis of visits with a final diagnosis of fever and upper respiratory tract infection, conditions for which there were few treatment protocols, confirmed the racial differences. Subgroup analysis in visits for head injury, for which there is an established evaluation protocol, did not find a lower odds of laboratory or radiological testing by race compared with non-Hispanic whites. Conclusions: Racial disparities in laboratory and radiological testing were present in pediatric ED visits. No racial differences were seen in the radiological and laboratory charges in the head injury subgroup, suggesting that evaluation algorithms can ameliorate racial disparities in pediatric ED care.