361 - Effect of Race and Ethnicity on Computed Tomography use in Children with Blunt Abdominal Trauma

Poster Number: 361
Publication Number: 361.404

Nisa atigapramoj, UCSF Benioff Children's Hospital Oakland, San Francisco, CA, United States; Kevan A. McCarten-Gibbs, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Irma Ugalde, McGovern Medical School at UTHealth Houston, Houston, TX, United States; Mohamed Badawy, University of Texas Southwestern Medical School, Dallas, TX, United States; Pradip P.. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kenneth Yen, UT Southwestern: The University of Texas Southwestern Medical Center, Dallas, TX, United States; Paul Ishimine, University of California, San Diego School of Medicine, San Diego, CA, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Nicole Kravitz-Wirtz, University of California, Davis, School of Medicine, Sacramento, CA, United States; Nathan Kuppermann, UC Davis School of Medicine, Sacrametno, CA, United States; James Holmes, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Prior data suggest racial and ethnic disparities in computed tomography (CT) use after blunt abdominal trauma in children.

Objective: Our objective was to determine if clinician-perceived patient race/ethnicity was associated with CT use. We hypothesized that previously identified disparities would be mitigated due to availability of a previously derived prediction rule for CT use in pediatric abdominal trauma.

Design/Methods: We performed an a priori analysis of a multicenter prospective study of children (< 18 years) with blunt abdominal trauma at six Level 1 pediatric trauma centers in which the previously-derived PECARN intra-abdominal injury prediction rule was being validated. Clinicians documented their perception of patient race as American Indian/Alaskan native, Asian, Black, Native Hawaiian/Pacific Islander, White, or other. Ethnicity was documented as Hispanic/Latino or non-Hispanic/Latino. The outcome of interest was abdominal CT use. Injury severity was assessed using the PECARN intra-abdominal injury clinical prediction rule. Socioeconomic status was calculated using a small-area composite social deprivation index based on patients’ zip codes.  We used multivariable logistic regression to control for site, age, sex, socioeconomic status and injury severity to calculate odds ratios (OR) for race and ethnicity on CT use.

Results: 7,542 patients were enrolled including 6,821 (90%) with both race and ethnicity documented, who served as the analytic population. The median age was 9.7 (IQR 5.2, 13.6) years, 3,856 (57%) were male, 1,803 (26%) had abdominal CT obtained and 506 (7%) had intra-abdominal injuries. Race was documented as: American Indian/Alaskan native 55 (0.8%), Asian 229 (3.4%), Black 1,751 (25.7%), Native Hawaiian/Pacific Islander 17 (0.3%), White 3,8937 (56.3%), or other/multiple 967 (14.2%). Ethnicity was documented as Hispanic/Latino in 3,006 (44%). In the multivariable analysis, compared to White patients, no significant differences in CT use were found for Asian (OR = 0.98, 95% CI 0.69, 1.40), Black (OR = 0.90, 95% CI 0.75, 1.08) or Hispanic patients (OR = 0.96, 95% CI 0.82, 1.14).

Conclusion(s): Previously identified racial and ethnic disparities in abdominal CT use for children with blunt abdominal trauma were not identified in this study in which an objective prediction rule was being validated. The use of the clinical prediction rule may have mitigated racial disparities in CT use.