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Race Plays Role in the Care Children Receive in Emergency Department

Tuesday, May 04, 2004

Depending on their race, children and their families may be treated differently in emergency departments throughout the United States, according to a study presented today at the Pediatric Academic Societies’ annual meeting in San Francisco. Conducted during 2003, the study includes data from emergency departments at 25 hospitals nationwide.

Physicians wanted to know if children of different races received significantly different emergency care. “We know from publications such as the Institute of Medicine’s “Unequal Treatment” that racial and ethnic disparities exist in many aspects of the health of our nation,” says the study’s lead author, Julius Goepp, M.D., chief of Pediatric Emergency Medicine at Golisano Children’s Hospital at Strong. “This study shows that the disparities affect children when are being treated in emergency departments.”

The study was conducted at member hospitals of the Pediatric Emergency Care Applied Research Network, a research network federally funded by Emergency Medical Services for Children, a division of the Maternal and Child Health Bureau of the Department of Health and Human Services. The network includes more than two dozen hospitals, including Children’s Hospital of Philadelphia and Children’s National Medical Center in Washington, D.C. Hospital personnel reviewed children’s charts on 10 randomly selected days during a three-month period. Analyses for this study focused on white and black children after it became apparent that those were the two largest groups in the study.

Physicians took a close look at how children who came to the emergency department with asthma and long-bone fractures – broken arms and legs – were cared for. Long-bone fractures and asthma were chosen to represent examples of a trauma diagnosis and a medical diagnosis, respectively. The study’s authors also examined the prior medical regimens of children who had asthma, and were treated in the emergency department. Finally, the study examines the frequency of social-services evaluation in a subset of children, including those who had burns, long-bone fractures, head trauma, and poisonings.

The study included a manual review of charts from 181 children who were diagnosed with long-bone fractures, of which 131 were white. Pain control was documented 2.3 times more for white children than black children.

            When examining the charts of 635 children who had asthma, of which 211 were white, there was no statistically significant difference in the medications administered during the emergency visit. However, physicians determined that white children were using asthma maintenance medications – intended to prevent sudden asthma attacks – 1.7 to 2 times more often than black children.

The study also examined the patterns of consultation of social workers and child abuse referrals. Among 499 children (336 of whom were white), who had burns, long-bone fractures, head trauma, or poisonings, black children were referred for social work or child abuse consultation 2.9 times more often than white children. “This study could not examine why these disparities are occurring, but this is a critical first step to describe them and to acknowledge that they exist,” Goepp says. “The next steps should be to conduct larger studies that will allow us to identify the causes of disparities, so we can offer a level playing field to all children.”

The study’s co-authors are Elizabeth Alpern, M.D. (a principal investigator of the PECARN Core Data Project), of Children’s Hospital of Philadelphia; Stephen Teach, M.D., and Jill Joseph, M.D., Ph.D., of Children’s National Medical Center in Washington, D.C.; and Stacey Knight, M. Stat., of the University of Utah.  Each author is a member of the Pediatric Emergency Care Applied Research Network.

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