Abstract
Introduction: The most common pediatric fractures involve the upper extremity. But there is limited study on racial disparity in diagnostic radiography for pediatric fractures. The literature has described the diagnostic accuracy of alternative diagnostic modalities with promising evidence of its ability to mitigate health inequity in primary care. Our objective was to understand if racial disparity exists in radiography for pediatric fractures.Methods: In this four-year retrospective cohort study, we analyzed rates of radiographic imaging and abnormal radiograph detection in 4280 pediatric patients (ages 3-18 years) who presented with chief complaints of arm or wrist pain and trauma-related International Classification of Diseases 10th Revision (ICD-10) codes. We compared White children to all other races and stratified by emergency departments (ED) vs all other primary care ambulatory service lines. Results: Non-White patients had lower imaging rate differences and lower odds receiving imaging in both ambulatory settings (0.65915, P = 0.0162; -5.4%, P = 0.0143) and in EDs (0.7732, P = 0.0369; -4.7%, P = 0.0368). Additionally, non-Whites in the ED had lower rates and lower odds of abnormal radiographs (-7.3%, P = 0.0084; 0.6794, P = 0.0089). Conclusion: Non-White patients seen in emergency and ambulatory settings had lower imaging rates for traumatic arm and wrist pain compared to White patients, indicating a healthcare disparity in pediatric imaging. Higher-level studies investigating the effect of social determinants of health, more detailed patient data, and provider bias on facture care equity are needed to understand underlying reasons for observed differences.
Highlights
The most common pediatric fractures involve the upper extremity
Patients presenting for traumatic arm and wrist pain were predominantly White (80.1%) with the highest representation in the age group of 14-18 years (41.5%), followed by ages 10-14 years (32.1%) and ages
There were significantly higher rates in the emergency departments (ED) compared to ambulatory service lines for both imaging rates (ED: 77.1%, Ambulatory: 17.1, difference: 60.0 %; CI: 57.5175% to 62.3316%, Chisquared: 1548.047, P < 0.0001) and abnormal radiograph rates (ED: 27.4%, Ambulatory: 22.3%, difference: 5.1 %; 0.2182% to 9.5674%, Chi-squared: 4.191, P = 0.0406)
Summary
The most common pediatric fractures involve the upper extremity. But there is limited study on racial disparity in diagnostic radiography for pediatric fractures. Our objective was to understand if racial disparity exists in radiography for pediatric fractures. Non-White minorities make up a significant portion of the United States (US) population; they have decreased access to care and increased spending, especially in emergency and inpatient care [1-4]. It is well described in the literature that pediatric insurance status impacts the amount of primary care received [5]. Compared with Whites, racial minorities have lower levels of health insurance coverage [6] and higher levels of costsharing, preventing low-income, highest-need populations from receiving needed care [7]. Costsharing (i.e., higher out-of-pocket costs) is associated with worse treatment compliance and higher hospitalization rates [8] - a feed-forward mechanism that inflates cost burden
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