311 - Effect of Race and Socioeconomic Status on the Evaluation of Febrile Infants

Poster Number: 311
Publication Number: 311.213

Maia Taft, UPMC Childrens Hospital of Pittsburgh, Aspinwall, PA, United States; Neema Shah, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Jessica Garrison, PHM, Allison Park, PA, United States; Catherine Forster, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States

Background: The evaluation of febrile infants younger than 60 days is guided by established protocols. However, structural racism and physicians’ implicit bias may affect how such clinical guidelines are applied.

Objective: To determine if self-identified race, insurance type, and neighborhood median household income (MHI), impacted the decision to be compliant with standard of care (SOC) in the evaluation of febrile infants.

Design/Methods: This was a 2 year retrospective chart review of all febrile infants ≤60 days old presenting to UPMC Children’s Hospital of Pittsburgh (between 1/1/15 and 12/31/17). SOC was defined as following the hospital’s clinical practice guideline, which recommended performing a lumbar puncture (LP) for all febrile infants ≤60 days unless an infant was >28 days and had RSV-positive bronchiolitis. MHI was determined using zip code and corresponding census data. Student’s t-test or chi-square analysis was used to identify variables associated with receiving SOC. Variables with a p < 0.1 on the univariate analysis were added to a logistic regression with race, MHI, and insurance type.

Results: There was a sample size of 1051 infants. Covariates included in the analysis included Ill-appearance, as defined by lethargy, toxic appearance, inconsolability or cyanosis; age at presentation; temperature on arrival; white blood cell count; absolute neutrophil count; urine white blood cell count; race; MHI; and insurance type. Age, temperature, and ill-appearance were significantly associated with receipt of SOC (Table 1). Race, insurance type, and MHI were not significantly associated with compliance with SOC (Table 1).Conclusion(s): Neither race, MHI, nor insurance status had a statistically significant impact on compliance with SOC of febrile infants from 2015-2017 suggesting that physician implicit bias did not lead to deviation from the clinical practice guideline. As recent national guidelines recommend performing fewer diagnostic tests and engaging in increased shared decision making in the evaluation of febrile infants, physician awareness of the impact of implicit bias and ongoing assessment of the role of factors such as race and SES in the clinical evaluation and outcomes of febrile infants will be critical.
Taft_CV1121.pdf