Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma

Joanne E. Natale, Jill G. Joseph, Alexander J. Rogers, Michael Tunik, David J Monroe, Benjamin Kerrey, Bema K. Bonsu, Lawrence J. Cook, Kent Page, Kathleen Adelgais, Kimberly Quayle, Nathan Kuppermann, James F. Holmes

Research output: Contribution to journalArticle

Abstract

Objectives The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma. Methods We performed a planned secondary analysis of a prospective observational cohort of children <18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals. Results Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0%), black non-Hispanic (n = 3,687, 34.1%), or Hispanic of any race (n = 1,291, 11.9%). Overall, 51.8% of white non-Hispanic, 32.7% of black non-Hispanic, and 44.2% of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95% CI = 0.8 to 1.1). Conclusions After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalAcademic Emergency Medicine
Volume23
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Physician-Patient Relations
Torso
Tomography
Pediatrics
Wounds and Injuries
Hispanic Americans
Physicians
Abdominal Injuries
Cluster Analysis
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Decision Support Techniques
Decision Making

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma. / Natale, Joanne E.; Joseph, Jill G.; Rogers, Alexander J.; Tunik, Michael; Monroe, David J; Kerrey, Benjamin; Bonsu, Bema K.; Cook, Lawrence J.; Page, Kent; Adelgais, Kathleen; Quayle, Kimberly; Kuppermann, Nathan; Holmes, James F.

In: Academic Emergency Medicine, Vol. 23, No. 5, 01.05.2016, p. 584-590.

Research output: Contribution to journalArticle

Natale, JE, Joseph, JG, Rogers, AJ, Tunik, M, Monroe, DJ, Kerrey, B, Bonsu, BK, Cook, LJ, Page, K, Adelgais, K, Quayle, K, Kuppermann, N & Holmes, JF 2016, 'Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma', Academic Emergency Medicine, vol. 23, no. 5, pp. 584-590. https://doi.org/10.1111/acem.12943
Natale, Joanne E. ; Joseph, Jill G. ; Rogers, Alexander J. ; Tunik, Michael ; Monroe, David J ; Kerrey, Benjamin ; Bonsu, Bema K. ; Cook, Lawrence J. ; Page, Kent ; Adelgais, Kathleen ; Quayle, Kimberly ; Kuppermann, Nathan ; Holmes, James F. / Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma. In: Academic Emergency Medicine. 2016 ; Vol. 23, No. 5. pp. 584-590.
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abstract = "Objectives The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma. Methods We performed a planned secondary analysis of a prospective observational cohort of children <18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals. Results Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0{\%}), black non-Hispanic (n = 3,687, 34.1{\%}), or Hispanic of any race (n = 1,291, 11.9{\%}). Overall, 51.8{\%} of white non-Hispanic, 32.7{\%} of black non-Hispanic, and 44.2{\%} of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95{\%} confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95{\%} CI = 0.8 to 1.1). Conclusions After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.",
author = "Natale, {Joanne E.} and Joseph, {Jill G.} and Rogers, {Alexander J.} and Michael Tunik and Monroe, {David J} and Benjamin Kerrey and Bonsu, {Bema K.} and Cook, {Lawrence J.} and Kent Page and Kathleen Adelgais and Kimberly Quayle and Nathan Kuppermann and Holmes, {James F.}",
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AU - Natale, Joanne E.

AU - Joseph, Jill G.

AU - Rogers, Alexander J.

AU - Tunik, Michael

AU - Monroe, David J

AU - Kerrey, Benjamin

AU - Bonsu, Bema K.

AU - Cook, Lawrence J.

AU - Page, Kent

AU - Adelgais, Kathleen

AU - Quayle, Kimberly

AU - Kuppermann, Nathan

AU - Holmes, James F.

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N2 - Objectives The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma. Methods We performed a planned secondary analysis of a prospective observational cohort of children <18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals. Results Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0%), black non-Hispanic (n = 3,687, 34.1%), or Hispanic of any race (n = 1,291, 11.9%). Overall, 51.8% of white non-Hispanic, 32.7% of black non-Hispanic, and 44.2% of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95% CI = 0.8 to 1.1). Conclusions After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.

AB - Objectives The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma. Methods We performed a planned secondary analysis of a prospective observational cohort of children <18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals. Results Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0%), black non-Hispanic (n = 3,687, 34.1%), or Hispanic of any race (n = 1,291, 11.9%). Overall, 51.8% of white non-Hispanic, 32.7% of black non-Hispanic, and 44.2% of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95% CI = 0.8 to 1.1). Conclusions After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.

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