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Social Factors Associated with Ultrasound Versus Computed Tomography Utilization Among Children Diagnosed with
Kennedy Sparling1, Garrett Trang2, Eric K Juang1
1The University of Arizona, College of Medicine, Phoenix, United States (K.S., E.K.J, M.H., C.M.P.).
Insights
Computed tomography (CT) is more common than ultrasound (US) for pediatric pyelonephritis in emergency departments, especially for older children and those from lower-income areas. Social determinants of health influence imaging choices.
Area of Science:
- Pediatric Nephrology
- Emergency Medicine
- Radiology
- Health Services Research
Background:
- Acute pyelonephritis in children can stem from lower urinary tract infections (UTIs).
- Imaging for pyelonephritis is not always necessary but can be crucial for atypical cases or suspected complications.
- Social determinants of health (SDoH) may influence healthcare decisions, including diagnostic imaging.
Purpose of the Study:
- To investigate the relationship between SDoH and the choice between computed tomography (CT) and ultrasound (US) for imaging pediatric patients with pyelonephritis in emergency departments.
- To identify demographic and facility-level factors associated with CT versus US utilization.
Main Methods:
- A multivariate logistic regression analysis was conducted using data from the Nationwide Emergency Department Sample (NEDS).
- The study included pediatric patients diagnosed with acute pyelonephritis (ICD-10: N10) who underwent either CT or US imaging between 2019 and 2020.
Main Results:
- Out of 39,528 pyelonephritis patients, 6,240 received imaging (74% CT, 26% US).
- Children over 3 years old were less likely to receive US compared to CT (p < 0.01).
- Patients from higher income zip codes (≥$82,000) were twice as likely to receive US (p = 0.024).
- US was more common at Level I trauma centers (OR: 4.45, p < 0.001) and metropolitan teaching hospitals (OR: 1.76, p = 0.05).
Conclusions:
- CT imaging is more frequently used for older pediatric patients, those from lower-income zip codes, and those treated at non-teaching hospitals.
- There is a need to minimize radiation exposure in pediatric pyelonephritis imaging.
- Further research should address potential barriers to care and the impact of SDoH on imaging decisions for pediatric pyelonephritis.
Rationale And Objectives:
Acute pyelonephritis can complicate lower urinary tract infections (UTI) in children. While often unnecessary, imaging may be helpful if clinical symptomatology is atypical or complications are suspected. As social determinants of health (SDoH) can impact care, this study examines the correlational relationship between SDoH and computed tomography (CT) versus ultrasound (US) when imaging is used in pediatric patients with pyelonephritis in the emergency department.
Materials And Methods:
A multivariate logistic regression analysis was performed using data from the Nationwide Emergency Department Sample (NEDS), including pediatric patients with acute pyelonephritis (ICD-10: N10) who received CT or US in 2019-2020.
Results:
Of the 39,528 patients diagnosed with pyelonephritis, 6240 patients received imaging with either CT (74%) or US (26%). Children >3 years old were significantly less likely to receive an US versus CT (p < 0.01). Patients from zip codes of median household incomes ≥$82,000 were twice as likely to receive an US (p = 0.024). US was more frequently used at level I trauma centers (OR: 4.45, p < 0.001) and metropolitan teaching hospitals (OR: 1.76, p = 0.05).
Conclusion:
Among children undergoing CT or US in the emergency department with an eventual diagnosis of pyelonephritis, CT is more often utilized for older patients, those from lower income zip codes, and those imaged at non-teaching hospitals. Further efforts should focus on minimizing radiation exposure as well as recognition of possible barriers to care and SDoH when imaging is associated with the diagnosis of pediatric pyelonephritis.
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