title: Disparities exist in the emergency department evaluation of pediatric chest pain.
abstract: OBJECTIVE
  To identify and describe disparities in the provision of Emergency Department (ED) care in pediatric patients presenting with chest pain (CP).
  
  
  METHODS
  Nationally representative data were drawn from the National Hospital Ambulatory Medical Care Survey (NHAMCS). All ED visits with a chief complaint of CP and age <19 years from 2002 to 2006 were analyzed. The primary outcome variable was "Anytest" performed (defined as any combination of complete blood count, electrocardiogram, and/or chest x-ray). Univariable analyses were performed with "Anytest" as the dependent variable and patient characteristics as independent variables. Multivariable analysis was performed using logistic regression with the same independent patient characteristics.
  
  
  RESULTS
  Eight hundred eighteen pediatric CP visits representing 2 552 193 such visits nationwide were analyzed. Gender and metro/non-metro location were not associated with "Anytest." However, Caucasian patients (p = 0.01) and those with private insurance (p < 0.01) were significantly more likely to receive testing despite otherwise similar demographics and severity of illness. Multivariate analysis revealed race (p = 0.03), expected payer (p = 0.003), and triage level (p = 0.009) were significantly and independently associated with the frequency of testing performed.
  
  
  CONCLUSIONS
  Disparities exist in the ED care of pediatric patients with CP. Identification of such variations is important and provides an opportunity for targeted interventions that ensure delivery of high-quality, cost-effective health care for children.
authors.affiliation: Pediatric Cardiology, Children's Hospital of Wisconsin, Wauwautosa, WI 53226, USA. jhambrook@chw.org
authors.forename: John T
authors.initials: JT
authors.lastname: Hambrook
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kimball
authors.forename: Phillip
authors.initials: P
authors.lastname: Khoury
authors.forename: James
authors.initials: J
authors.lastname: Cnota
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001772:Blood Cell Count / Q000706:statistics & numerical data; D002637:Chest Pain / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010372:Pediatrics / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000706:statistics & numerical data