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

O RIGINAL C ONTRIBUTION Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma JoAnne E. Natale, MD, PhD, Jill G. Joseph, MD, PhD, Alexander J. Rogers, MD, Michael Tunik, MD, David Monroe, MD, Benjamin Kerrey, MD, MS, Bema K. Bonsu, MD, Lawrence J. Cook, MStat, PhD, Kent Page, MStat, Kathleen Adelgais, MD, MPH, Kimberly Quayle, MD, Nathan Kuppermann, MD, MPH, and James F. Holmes, MD, MPH 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 From the Department of Pediatrics (JEN, NK), the Betty Irene Moore School of Nursing (JGJ), and the Department of Emergency Medicine (NK, JFH), University of California at Davis, Sacramento, CA; the Departments of Emergency Medicine and Pediatrics, University of Michigan Medical Center and University of Michigan School of Medicine (AJR), Ann Arbor, MI; the Departments of Pediatrics and Emergency Medicine, New York University School of Medicine (MT), New York City, NY; Howard County General Hospital, Columbia (DM), MD; the Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati (BK), OH; the Department of Pediatrics, Nationwide Children’s Hospital (BKB), Columbus, OH; the Department of Pediatrics, University of California at San Diego (BKB), San Diego, CA; the University of Utah (LJC, KP), Salt Lake City, UT; the Department of Pediatrics and Emergency Medicine, University of Colorado (KA), Denver, CO; and the St. Louis Children’s Hospital, Washington University (KQ), St. Louis, MO. Participating centers and site investigators for the Pediatric Emergency Care Applied Research Network (PECARN) are listed in Appendix A. Received September 7, 2015; revision received December 2, 2015; accepted December 14, 2015. This work was presented in part at the Society for Academic Emergency Medicine Annual Meeting, Dallas, TX, May 2014. This work was supported by a grant from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 1 R49CE00100201. The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685 from the EMSC program of the MCHB/HRSA. Supervising Editor: Jennifer D. H. Walthall, MD. Address for correspondence and reprints: JoAnne E. Natale, MD, PhD, FAAP; e-mail: jenatale@ucdavis.edu. ISSN 1069-6563 PII ISSN 1069-6563583 © 2016 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12943