Related Experiment Video
Updated: Jul 11, 2025
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants
Colleen K Gutman1,2, Paul L Aronson3,4, Nidhi V Singh5
1Department of Emergency Medicine, University of Florida College of Medicine, Gainesville.
Insights
Language barriers, not race or ethnicity, were linked to unnecessary interventions in febrile infants. Addressing communication gaps is crucial for equitable care in pediatric emergency medicine.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Equity
Background:
- Febrile infants at low risk for invasive bacterial infections often receive unnecessary lumbar punctures, antibiotics, or hospitalization.
- Existing research has not clarified if race, ethnicity, or language influences these management decisions.
Purpose of the Study:
- To examine the association between race, ethnicity, language, and the utilization of lumbar puncture, empirical antibiotics, and hospitalization in well-appearing, low-risk febrile infants.
- To identify potential disparities in the management of febrile infants based on demographic factors.
Main Methods:
- A multicenter, retrospective, cross-sectional analysis was conducted using data from pediatric emergency departments between 2018 and 2019.
- Included were 4042 well-appearing febrile infants (29-60 days old) deemed low-risk based on blood and urine tests.
- Logistic regression models were used to assess the association between infant race/ethnicity, language, and receipt of interventions.
Main Results:
- Race and ethnicity were not significantly associated with the composite outcome of receiving at least one nonindicated intervention.
- Infants from families using a language other than English had higher odds of receiving at least one nonindicated intervention (aOR, 1.16).
- Hispanic infants showed lower odds of hospital admission, while infants using a non-English language had higher odds of hospital admission.
Conclusions:
- Language used for medical care, rather than race or ethnicity, was associated with the use of nonindicated interventions in low-risk febrile infants.
- Findings underscore the complex interplay of race, ethnicity, language, and health inequities.
- Future guidelines must prioritize patient-centered communication and address potential disparities related to language barriers to ensure equitable care.
Importance:
Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language.
Objective:
To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection.
Design, Setting, And Participants:
This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source.
Exposures:
Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English).
Main Outcomes And Measures:
The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes.
Results:
Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46).
Conclusions And Relevance:
Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.
Related Concept Videos
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:26Patterns of Fever
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...