Pediatric ED imaging gaps persist by race and insurance status

Children from racial and ethnic minority groups and those covered by public insurance were less likely to receive selected radiology studies in emergency departments than white and privately insured children, according to a study published May 20 in JAMA Network Open.

The cohort study included 857,034 pediatric ED visits from 2019 across 8 U.S. states. Margaret E. Samuels-Kalow, MD, MPhil, MSHP, of Massachusetts General Hospital, led the study with colleagues from several institutions.

Researchers evaluated 3 imaging measures used as markers of judicious radiology imaging in pediatric emergency care: chest radiography for asthma, head CT for head trauma, and abdominal CT for abdominal trauma. The cohorts included 380,719 asthma visits, 435,644 head trauma visits, and 40,671 abdominal trauma visits.

After adjustment for age, sex, clinical severity, and hospital factors, children with public insurance had lower odds of imaging across all 3 measures than children with private insurance. The adjusted odds ratios were 0.85 for chest radiography in asthma, 0.77 for head CT in head trauma, and 0.59 for abdominal CT in abdominal trauma.

Racial and ethnic differences also remained after adjustment. Compared with non-Hispanic white children, non-Hispanic Black children had lower odds of chest radiography for asthma, head CT for head trauma, and abdominal CT for abdominal trauma, according to the authors.

Hospital pediatric capability was associated with differences in overall imaging utilization. However, it was not associated with changes in the pattern of imaging-use differences by insurance status or race and ethnicity, the group reported.

“This study suggests that additional efforts are needed to ensure that efforts to enhance pediatric capabilities address both the quality and equity of care,” the authors wrote.

The authors noted that optimal imaging rates are difficult to define from administrative data alone because they are closely tied to underlying patient severity. They also noted that the data could not identify imaging performed specifically within the ED for all patients, although a sensitivity analysis of discharged patients showed similar results.

“Imaging decisions are based on clinical factors and not on demographic characteristics,” the authors concluded.