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Racial Differences in Urine Testing of Febrile Young Children Presenting to Pediatric Hospitals

Sriram Ramgopal1,2, Nichell Tidwell3, Nader Shaikh4

  • 1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. sramgopal@luriechildrens.org.

Journal of Racial and Ethnic Health Disparities
|November 15, 2021
PubMed

Insights

Black children received less urine testing for urinary tract infections (UTIs) in emergency departments, but this did not lead to more missed diagnoses or revisits. Further research is needed to understand these disparities in pediatric UTI care.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Health Equity

Background:

  • Historical practice guidelines suggested lower urinary tract infection (UTI) risk in Black children.
  • Race-based clinical decisions raise concerns about potential disparities in healthcare.
  • Investigating disparities in diagnostic testing for febrile young children is crucial.

Purpose of the Study:

  • To examine urine testing rates (urinalysis and/or urine culture) among young febrile children in the emergency department (ED) by race/ethnicity.
  • To assess the association between race/ethnicity and UTI diagnosis and 7-day revisits.
  • To identify potential missed diagnoses related to race-based testing variations.

Main Methods:

  • A multicenter retrospective cohort study included 734,730 children aged 2-24 months with fever across 26 US EDs (2009-2019).
  • Longitudinal testing trends were evaluated using a generalized linear mixed-effects model.
  • Associations of race/ethnicity with testing, UTI diagnoses, and revisits were characterized.

Main Results:

  • Black children constituted 24.1% of the cohort and showed lower urine testing rates (23.4%) compared to White (31.7%) and Hispanic (33.9%) children.
  • Black patients had significantly lower adjusted odds of receiving urine testing (OR 0.70; 95% CI 0.69-0.71).
  • Among tested patients, UTI diagnosis rates were 2.4% for Black children versus 3.3% for White children. Return visits within 7 days were slightly higher for Black children who received testing on the index visit (8.5%) compared to those who did not (7.6%).

Conclusions:

  • Black patients experienced lower rates of urine testing and UTI diagnoses in the ED setting.
  • These disparities in testing were not linked to increased rates of missed diagnoses or unscheduled return visits.
  • Further investigation is warranted to understand and address the observed racial disparities in pediatric UTI diagnostic practices.
Abstract

Keywords:
DisparitiesEmergency service, HospitalMissed diagnosisUrinary tract infections

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