title: Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma.
abstract: The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma.
  
  
  
  We performed a planned secondary analysis of a prospective observational cohort of children < 18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals.
  
  
  
  Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0%), black non-Hispanic (n = 3,687, 34.1%), or Hispanic of any race (n = 1,291, 11.9%). Overall, 51.8% of white non-Hispanic, 32.7% of black non-Hispanic, and 44.2% of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95% CI = 0.8 to 1.1).
  
  
  
  After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.
authors.affiliation: Department of Pediatrics, University of California at Davis, Sacramento, CA.
authors.forename: JoAnne E
authors.initials: JE
authors.lastname: Natale
authors.affiliation: Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA.
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
authors.affiliation: Departments of Emergency Medicine and Pediatrics, University of Michigan Medical Center and University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Rogers
authors.affiliation: Departments of Pediatrics and Emergency Medicine, New York University School of Medicine, New York City, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Tunik
authors.affiliation: Howard County General Hospital, Columbia, MD.
authors.forename: David
authors.initials: D
authors.lastname: Monroe
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kerrey
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.|Department of Pediatrics, University of California at San Diego, San Diego, CA.
authors.forename: Bema K
authors.initials: BK
authors.lastname: Bonsu
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Kent
authors.initials: K
authors.lastname: Page
authors.affiliation: Department of Pediatrics and Emergency Medicine, University of Colorado, Denver, CO.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adelgais
authors.affiliation: St. Louis Children's Hospital, Washington University, St. Louis, MO.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quayle
authors.affiliation: Department of Pediatrics, University of California at Davis, Sacramento, CA.|Department of Emergency Medicine, University of California at Davis, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: Department of Emergency Medicine, University of California at Davis, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D044465:White People / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*