Association Between Residential Rurality and Diagnostic Imaging Use in Pediatric Dog-Bite Encounters: A...

Area of Science:

• Pediatric Emergency Medicine
• Radiology Utilization
• Health Services Research

Background:

• Diagnostic imaging is crucial for evaluating pediatric dog-bite injuries.
• Utilization of imaging services may differ based on geographic location (rural vs. urban).

Purpose of the Study:

• To investigate the association between rural-urban commuting area (RUCA) classification and diagnostic imaging use in pediatric dog-bite encounters.
• To determine if residence location influences imaging decisions for children treated for dog bites in US children's hospitals.

Main Methods:

• Retrospective cross-sectional study using the Pediatric Health Information System (PHIS) database (2021-2022).
• Included patients ≤18 years with dog-bite International Classification of Diseases, 10th Revision (ICD-10) codes.
• Analyzed imaging utilization (radiography, ultrasound, CT, MRI) based on RUCA codes using multivariable logistic regression.

Main Results:

• Among 13,901 encounters, 21.5% received imaging.
• Higher RUCA codes (indicating more rural areas) were associated with increased odds of imaging (OR ≈ 1.05 per point).
• The most rural areas showed approximately 8.61 percentage points higher absolute imaging rates compared to the most urban areas.

Conclusions:

• Rural residence is linked to higher diagnostic imaging use for pediatric dog-bite injuries in children's hospitals.
• Findings suggest practice pattern variations or case-mix differences, warranting further investigation.
• While system-level relevance exists, individual encounter impact appears modest.