Hospital and Emergency Department Pediatric Capability, Patient Characteristics, and Radiology Imaging for Children

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Health Equity

Background:

• Judicious use of radiology imaging is crucial in pediatric emergency care.
• Prior research indicates disparities in imaging utilization based on insurance status and race/ethnicity.

Purpose of the Study:

• To investigate whether hospital and emergency department (ED) pediatric capabilities influence the association between insurance, race/ethnicity, and imaging utilization in children.
• To examine disparities in pediatric imaging use.

Main Methods:

• Retrospective cohort study using 2019 State Emergency Department and State Inpatient Databases from 8 states, linked with national ED inventory and pediatric readiness data.
• Analysis included over 857,000 pediatric ED visits for asthma, head trauma, or abdominal trauma.
• Mixed-effects logistic regression models adjusted for patient and hospital factors to assess imaging utilization by insurance and race/ethnicity.

Main Results:

• Children with public insurance were less likely to undergo recommended imaging compared to those with private insurance across all conditions.
• Non-Hispanic Black and Hispanic children were less likely to undergo imaging compared to non-Hispanic White children.
• While pediatric capabilities were associated with some differences in imaging use, they did not change the disparities observed based on insurance or race/ethnicity.

Conclusions:

• Increased pediatric capability in emergency departments did not mitigate disparities in imaging utilization by insurance status or race/ethnicity.
• Further interventions are necessary to ensure that pediatric capabilities enhance the quality and equity of emergency care for all children.
• Addressing systemic inequities in pediatric imaging is essential.