Regional and socioeconomic disparities in emergency department use of radiographic imaging for acute pediatric sinusitis.
BACKGROUND
Acute pediatric sinusitis (APS) is a common complication of pediatric upper respiratory tract infections. Children with all degrees of APS severity may present to emergency departments (EDs) for evaluation and management. This study was designed to analyze the use of imaging in APS presenting to U.S. EDs.


METHODS
A cross-sectional analysis of the 2008 National Emergency Department Sample database was performed. One hundred one thousand six hundred sixty children, aged ≤18 years, assigned at least one ICD9 code for APS were identified. Current procedural terminology codes for sinus plain film radiographs, computed tomography (CT), and magnetic resonance imaging identified children who underwent sinus imaging. Association of performance of sinus imaging was sought with multiple predictor variables including clinicodemographic and hospital characteristics.


RESULTS
The use of any imaging was associated with older age (odds ratio [OR] = 1.07; p < 0.001), male gender (OR = 1.57; p < 0.001), and diagnosis of chronic rhinosinusitis (OR = 2.46; p < 0.001). Imaging was more common in metropolitan teaching (OR = 1.40;0 p < 0.001) and nonteaching (OR = 5.64; p < 0.001) hospitals. Markers of higher socioeconomic status--private health insurance (OR = 1.37; p < 0.001) and higher income level (OR = 1.96; p < 0.001)--were associated with greater use of imaging, especially CT scans.


CONCLUSIONS
The use of ED imaging in APS is appropriately associated with factors known to be associated with APS complications. However, additional disparities with respect to regional and socioeconomic factors exist. Interventions to eliminate these health care disparities in use of imaging resources may lead to quality improvement in care and outcomes for APS.
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Ahmad R
AR
Sedaghat
Michael J
MJ
Cunningham
Stacey L
SL
Ishman
D000208:Acute Disease; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006785:Hospitals, University; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012737:Sex Factors; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012959:Socioeconomic Factors; D014057:Tomography, X-Ray Computed; D014481:United States