363 - Relationship between patient racial and ethnic diversity and imaging variation at U.S. children’s hospital emergency departments

Poster Number: 363
Publication Number: 363.313

Margaret Samuels-Kalow, MassGeneral Hospital for Children, Boston, MA, United States; Heidi G. De Souza, Children's Hospital Association, Lenexa, KS, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States; Elizabeth R. Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jennifer Marin, UPMC Childrens Hospital of Pittsburgh, PIttsburgh, PA, United States; Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Matthew Hall, Children's Hospital Association, Lenexa, Kansas, KS, United States; Paul L. Aronson, Yale School of Medicine, New Haven, CT, United States; Alon Peltz, Harvard Medical School, Boston, MA, United States; Jordee M. Wells, Nationwide Children's Hospital, Columbus, OH, United States; Colleen K. Gutman, University of Florida, Gainesville, FL, United States; Harold Simon, Emory University School of Medicine and Children's healthcare of Atlanta, atlanta, GA, United States; Kristen H. Shanahan, Boston Children's Hospital, Boston, MA, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States

Background: Lower rates of diagnostic imaging have been observed among Black children compared to White children in pediatric emergency departments. Although the racial composition of children served by each hospital differs, it is unclear this impacts overall imaging rates at the hospital level, and in particular how it may impact the difference in imaging rates between Black and White children at a given hospital.

Objective: Our primary objective was to quantify the correlation between the diversity of pediatric patients seen at each pediatric ED and variation in diagnostic imaging.

Design/Methods: This cross-sectional analysis using the Pediatric Health Information System examined diagnostic imaging during ED visits by patients younger than 18 years at 38 children’s hospitals from January 1, 2016, through December 31, 2019. The primary outcome was receipt of diagnostic imaging defined as x-ray, ultrasound, CT or MRI. We used generalized linear modeling to calculate adjusted odds ratios (aORs) to measure differences in imaging by race/ethnicity at the hospital level. We examined the correlation between the proportion of non-White patients cared for at each hospital and the aOR for receipt of diagnostic imaging by race/ethnicity.

Results: There were 12,310,344 ED visits by 5,883,664 children during the study period, of which 3,527,866 visits (28.7%) involved at least one diagnostic imaging test. Non-Hispanic Black children were consistently less likely to receive diagnostic imaging than non-Hispanic White children at each hospital, and for all imaging modalities. There was a statistically significant correlation between the proportion of non-White patients cared for at the hospital and greater imaging difference between non-Hispanic White and non-Hispanic Black patients. (correlation coefficient -0.37, p=0.02).Conclusion(s): Hospitals with a higher percentage of non-White patients had larger differences in imaging between non-Hispanic Black and non-Hispanic White patients, with non-Hispanic White patients consistently more likely to receive diagnostic imaging. These findings emphasize the urgent need for interventions at the hospital level to improve equity in imaging in pediatric emergency medicine.