Objective:

To evaluate the impact of pediatric emergency care capability on imaging patterns in pediatric patients treated in emergency departments, particularly concerning insurance status and race/ethnicity.

Approach:

• Study Design: Retrospective cohort study analyzing 2019 data from multiple states linked with the National Pediatric Readiness Project survey.
• Population: Included 857,034 emergency department visits among patients aged 18 years or younger with asthma, head trauma, or abdominal trauma.
• Assessment: Pediatric capability was assessed through the presence of pediatric emergency care coordinators, pediatric readiness scores, and hospital pediatric resources.

Key Findings:

• Pediatric patients with public insurance and those identifying as Hispanic or Black were less likely to undergo imaging compared to privately insured or White patients.
• Increased pediatric capability was associated with lower overall imaging utilization but did not reduce disparities in imaging by race, ethnicity, or insurance status.
• Imaging rates were 32% for chest radiography, 19% for head CT, and 17% for abdominal CT among the studied population.
• 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 compared to privately insured patients.

Interpretation:

Limitations:

• Reliance on administrative data with limited clinical detail.
• Inability to distinguish imaging performed in the emergency department from that obtained after hospital admission.
• Lack of triage acuity measures in the data sets.

Conclusion:

Sources:

• JAMA Network Open