title: Racial disparities in ordering laboratory and radiology tests for pediatric patients in the emergency department.
abstract: OBJECTIVE
  The objective of this study was to examine the association of race and language on laboratory and radiological testing in the pediatric emergency department (ED).
  
  
  METHODS
  This retrospective, case-cohort study examined laboratory and radiological testing among patients discharged home from 2 urban, pediatric EDs between March 2, 2009, and March 31, 2010.
  
  
  RESULTS
  There were 75,254 visits among 49,164 unique patients, of whom 31.0% had laboratory and 30.5% had radiological testing. African American (adjusted odds ratio [aOR], 0.93; confidence interval [CI], 0.89-0.98; P = 0.004) and biracial racial categories (aOR, 0.91; CI, 0.86-0.98; P = 0.007) were associated with decreased odds of laboratory testing compared with non-Hispanic whites. Similarly, Native American (aOR, 0.82; CI, 0.73-0.94), African American (aOR0.81; CI, 0.72-0.81), biracial (aOR, 0.82; CI, 0.77-0.88), Hispanic (aOR.76; CI, 0.72-0.81), and "other" (aOR, 0.84; CI, 0.73-0.97) racial categories were each associated with lower odds of radiological testing compared with non-Hispanic whites. Subgroup analysis of visits with a final diagnosis of fever and upper respiratory tract infection, conditions for which there were few treatment protocols, confirmed the racial differences. Subgroup analysis in visits for head injury, for which there is an established evaluation protocol, did not find a lower odds of laboratory or radiological testing by race compared with non-Hispanic whites.
  
  
  CONCLUSIONS
  Racial disparities in laboratory and radiological testing were present in pediatric ED visits. No racial differences were seen in the radiological and laboratory charges in the head injury subgroup, suggesting that evaluation algorithms can ameliorate racial disparities in pediatric ED care.
authors.affiliation: Department of Quality, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA. Rob.Payne@ChildrensMN.org
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
authors.forename: Susan E
authors.initials: SE
authors.lastname: Puumala
mesh_terms: D000293:Adolescent; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D003441:Crowding; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007223:Infant; D008910:Minnesota; D010351:Patient Discharge / Q000706:statistics & numerical data; D063505:Racism; D011859:Radiography / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American