Racial Disparities in Ordering Laboratory and Radiology Tests for Pediatric Patients in the Emergency Department
Racial Disparities in Ordering Laboratory and Radiology Tests for Pediatric Patients in the Emergency Department
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DOI：
10.1097/pec.0b013e31828e6489
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发表时间：
2013-05-01
影响因子：
1.4
通讯作者：
Puumala, Susan E.
中科院分区：
文献类型：
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作者：
Payne, Nathaniel R.;Puumala, Susan E.
目的：本研究的目的是检查种族和语言对儿科急诊科（艾德）实验室和放射学检查的关联。方法：本回顾性病例队列研究检查了2009年3月2日至2010年3月31日期间从2个城市儿科急诊科出院回家的患者的实验室和放射学检查。结果：在49，164名独特患者中有75，254次就诊，其中31.0%进行了实验室检查，30.5%进行了放射学检查。与非西班牙裔白人相比，非裔美国人（调整后的比值比[aOR]，0.93;置信区间[CI]，0.89-0.98; P = 0.004）和双种族类别（aOR，0.91; CI，0.86-0.98; P = 0.007）与实验室检查的比值降低相关。同样，美洲原住民（aOR，0.82; CI，0.73-0.94），非裔美国人（aOR 0.81; CI，0.72-0.81），birthday（aOR，0.82; CI，0.77-0.88），西班牙裔与非西班牙裔白人相比，“其他”（aOR，0.84; CI，0.73-0.97）种族类别分别与放射学检查的较低几率相关。对最终诊断为发热和上呼吸道感染的访视进行的亚组分析证实了种族差异，这些疾病的治疗方案很少。亚组分析在访问头部损伤，有一个既定的评估协议，没有发现一个较低的赔率的实验室或放射学检查的种族相比，非西班牙裔white.Conclusions：在实验室和放射学检查的种族差异存在于儿科艾德访问。在颅脑损伤亚组的放射学和实验室检查费用中没有发现种族差异，这表明评估算法可以改善儿科艾德护理中的种族差异。
Objective: The objective of this study was to examine the association of race and language on laboratory and radiological testing in the pediatric emergency department (ED).Methods: This retrospective, case-cohort study examined laboratory and radiological testing among patients discharged home from 2 urban, pediatric EDs between March 2, 2009, and March 31, 2010.Results: There were 75,254 visits among 49,164 unique patients, of whom 31.0% had laboratory and 30.5% had radiological testing. African American (adjusted odds ratio [aOR], 0.93; confidence interval [CI], 0.89-0.98; P = 0.004) and biracial racial categories (aOR, 0.91; CI, 0.86-0.98; P = 0.007) were associated with decreased odds of laboratory testing compared with non-Hispanic whites. Similarly, Native American (aOR, 0.82; CI, 0.73-0.94), African American (aOR0.81; CI, 0.72-0.81), biracial (aOR, 0.82; CI, 0.77-0.88), Hispanic (aOR.76; CI, 0.72-0.81), and "other" (aOR, 0.84; CI, 0.73-0.97) racial categories were each associated with lower odds of radiological testing compared with non-Hispanic whites. Subgroup analysis of visits with a final diagnosis of fever and upper respiratory tract infection, conditions for which there were few treatment protocols, confirmed the racial differences. Subgroup analysis in visits for head injury, for which there is an established evaluation protocol, did not find a lower odds of laboratory or radiological testing by race compared with non-Hispanic whites.Conclusions: Racial disparities in laboratory and radiological testing were present in pediatric ED visits. No racial differences were seen in the radiological and laboratory charges in the head injury subgroup, suggesting that evaluation algorithms can ameliorate racial disparities in pediatric ED care.