Pediatric emergency care capability may not improve imaging patterns in pediatric patients treated in emergency departments based on insurance status as well as race and ethnicity.
Investigators analyzed 2019 data from the State Emergency Department and State Inpatient Databases in Arkansas, Florida, Iowa, Maryland, Nebraska, New York, Vermont, and Wisconsin linked with the National Emergency Department Inventory–USA and the 2021 National Pediatric Readiness Project survey. The retrospective cohort study included 857,034 emergency department visits among patients aged 18 years or younger with asthma, head trauma, or abdominal trauma.
Pediatric patients with public insurance and those who identified as Hispanic or Black were less likely to undergo imaging compared with privately insured or White patients. Increased pediatric capability was associated with lower imaging utilization overall but “not with amelioration of differences in imaging utilization by race and ethnicity or insurance status,” wrote lead study author Margaret E. Samuels-Kalow, MD, MPhil, MSHP, of the Department of Emergency Medicine at Massachusetts General Hospital, and colleagues.
The study evaluated chest radiography among patients with asthma, head computed tomography (CT) among those with head trauma, and abdominal CT among those with abdominal trauma. Pediatric capability was assessed using the presence of a pediatric emergency care coordinator, pediatric readiness scores, and hospital pediatric resources such as pediatric intensive care availability.
Among about 381,000 visits for asthma, 436,000 visits for head trauma, and 41,000 visits for abdominal trauma, imaging rates were 32% for chest radiography, 19% for head CT, and 17% for abdominal CT.
The patients with public insurance consistently underwent less imaging compared with patients with private insurance. Compared with privately insured patients, publicly insured patients had 15% lower odds of chest radiography for asthma, 23% lower odds of head CT for head trauma, and 41% lower odds of abdominal CT for abdominal trauma following adjustment for demographic and hospital factors.
Differences by race and ethnicity followed a similar pattern. Compared with non-Hispanic White patients, non-Hispanic Black patients had 17% lower odds of chest radiography, 23% lower odds of head CT, and 40% lower odds of abdominal CT. Hispanic patients also underwent imaging less often across all three measures.
Hospitals with pediatric emergency care coordinators and higher pediatric readiness scores generally had lower overall imaging rates for chest radiography and head CT. However, the relative differences between racial and ethnic as well as insurance groups remained similar across hospitals with varying levels of pediatric capability.
Sensitivity analyses limited to patients discharged directly from the emergency department produced similar findings.
The investigators noted several limitations, including reliance on administrative data with limited clinical detail. The data sets did not include triage acuity measures and could not always distinguish imaging performed in the emergency department from that obtained following hospital admission. The study also could not determine whether lower imaging rates reflected appropriate reductions in low-value imaging or differences in care delivery.
“Additional efforts are needed to ensure that pediatric capability improves quality and equity of care,” the study authors concluded.
The study was funded by the National Institutes of Health. The study authors reported no conflicts of interest.
Source: JAMA Network Open
