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Racial and ethnic disparities in diagnostic imaging for child physical abuse
Denise C Abdoo1, Henry T Puls2, Matt Hall3
1University of Colorado Anschutz Medical Campus, Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States of America.
Insights
Racial bias did not consistently impact occult injury testing for child abuse, with no clear disparities found in diagnostic imaging or abuse-related injury diagnoses across racial groups. This study examined testing decisions in children
Area of Science:
- Pediatric medicine
- Medical imaging
- Health equity
Background:
- Racial bias may influence medical decisions for children suspected of abuse.
- Occult injury testing is crucial for diagnosing abuse in children.
Purpose of the Study:
- To investigate the association between race and occult injury testing decisions in children at children's hospitals.
- To identify potential racial disparities in diagnostic imaging and abuse-related injury diagnoses.
Main Methods:
- Retrospective study using the Pediatric Health Information System (PHIS) database (2017-2019).
- Analysis of three cohorts: infants with traumatic brain injury (TBI), children <2 years with extremity fractures, and children <2 years receiving a skeletal survey (SS).
- Measured odds of receiving guideline-recommended imaging and abuse-related injury diagnoses, adjusting for demographic and hospital factors.
Main Results:
- No difference in SS for TBI by race. Rib fracture odds were higher in non-Hispanic Black vs. Hispanic and non-Hispanic White infants with TBI.
- SS rates for extremity fractures were higher in non-Hispanic Black vs. Hispanic and non-Hispanic White children, but rib fracture rates did not differ by race.
- Neuroimaging rates for skeletal surveys did not differ by race. TBI odds differed by race, with lower odds in non-Hispanic Black vs. Hispanic patients.
Conclusions:
- No consistent pattern of race-based disparities in occult injury testing was identified when considering the diagnostic yield for abuse-related injuries.
- Further research may be needed to fully understand the complex interplay of race, testing, and diagnosis in child abuse evaluations.
Importance:
Racial bias may affect occult injury testing decisions for children with concern for abuse.
Objectives:
To determine the association of race on occult injury testing decisions at children's hospitals.
Design:
In this retrospective study, we measured disparities in: (1) the proportion of visits for which indicated diagnostic imaging studies for child abuse were obtained; (2) the proportion of positive tests.
Setting:
The Pediatric Health Information System (PHIS) administrative database encompassing 49 tertiary children's hospitals during 2017-2019.
Participants:
We built three cohorts based on guidelines for diagnostic testing for child abuse: infants with traumatic brain injury (TBI; n = 1952), children <2 years old with extremity fracture (n = 20,842), and children <2 years old who received a skeletal survey (SS; n = 13,081).
Main Outcomes And Measures:
For each group we measured: (1) the odds of receiving a specific guideline-recommended diagnostic imaging study; (2) among those with the indicated imaging study, the odds of an abuse-related injury diagnosis. We calculated both unadjusted and adjusted odds ratios (AOR) by race and ethnicity, adjusting for sex, age in months, payor, and hospital.
Results:
In infants with TBI, the odds of receiving a SS did not differ by racial group. Among those with a SS, the odds of rib fracture were higher for non-Hispanic Black than Hispanic (AOR 2.05 (CI 1.31, 3.2)) and non-Hispanic White (AOR 1.57 (CI 1.11, 2.32)) patients. In children with extremity fractures, the odds of receiving a SS were higher for non-Hispanic Black than Hispanic and non-Hispanic White patients (AOR 1.97 (CI 1.74, 2.23)); (AOR 1.17 (CI 1.05, 1.31)), respectively, and lower for Hispanic than non-Hispanic White patients (AOR 0.59 (CI 0.53, 0.67)). Among those receiving a SS, the rate of rib fractures did not differ by race. In children with skeletal surveys, the odds of receiving neuroimaging did not differ by race. Among those with neuroimaging, the odds of a non-fracture, non-concussion TBI were lower in non-Hispanic Black than Hispanic patients (AOR 0.7 (CI 0.57, 0.86)) and were higher among Hispanic than non-Hispanic White patients (AOR 1.23 (CI 1.02, 1.47)).
Conclusions And Relevance:
We did not identify a consistent pattern of race-based disparities in occult injury testing when considering the concurrent yield for abuse-related injuries.
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