Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants.

Autor:	Gutman CK; Department of Emergency Medicine, University of Florida College of Medicine, Gainesville.; Department of Pediatrics, University of Florida College of Medicine, Gainesville., Aronson PL; Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut., Singh NV; Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas., Pickett ML; Department of Pediatrics, Medical College of Wisconsin, Milwaukee., Bouvay K; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio., Green RS; Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Roach B; Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee., Kotler H; Division of Emergency Medicine, The George Washington University School of Medicine and Health Sciences and Children's National Health System, Washington, DC., Chow JL; Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, California.; Department of Emergency Medicine, University of California, Los Angeles., Hartford EA; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle., Hincapie M; Department of Pediatrics, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.; Division of Pediatric Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida., St Pierre-Hetz R; Department of Pediatrics, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Kelly J; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Sartori L; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Hoffmann JA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Corboy JB; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Bergmann KR; Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota., Akinsola B; Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia., Ford V; Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia., Tedford NJ; Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City., Tran TT; Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City., Gifford S; Ronald O. Perelman Department of Emergency Medicine/New York University Langone Health, New York, New York.; Department of Emergency Medicine, Weill Cornell Medical College, New York, New York., Thompson AD; Department of Pediatrics, Nemours Children's Hospital of Delaware, Wilmington., Krack A; Department of Pediatrics, School of Medicine, Section of Emergency Medicine, University of Colorado and Children's Hospital Colorado, Aurora., Piroutek MJ; Department of Emergency Medicine, University of California Irvine and Children's Hospital of Orange County, Orange., Lucrezia S; Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky., Chung S; Department of Emergency Medicine, Oregon Health and Science University, Portland.; Department of Pediatrics, Oregon Health and Science University, Portland., Chowdhury N; Division of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, Maryland., Jackson K; Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston., Cheng T; Department of Emergency Medicine, Harbor University of California Los Angeles Medical Center and the David Geffen School of Medicine at the University of California, Los Angeles., Pulcini CD; Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington.; Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington., Kannikeswaran N; Department of Pediatrics, Central Michigan University College of Medicine and Children's Hospital of Michigan, Detroit., Truschel LL; Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina., Lin K; Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina., Chu J; Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas.; Texas Children's Pediatrics, Houston., Molyneaux ND; Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas., Duong M; Division of Pediatric Emergency Medicine, Southern Illinois University, Carbondale., Dingeldein L; Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio., Rose JA; Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio., Theiler C; Department of Emergency Medicine, University of Iowa, Iowa City., Bhalodkar S; Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut., Powers E; Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut., Waseem M; Department of Pediatrics, Lincoln Medical Center, Bronx, New York.; Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York., Lababidi A; Department of Emergency Medicine, University of Florida College of Medicine, Gainesville.; Department of Pediatrics, University of Florida College of Medicine, Gainesville., Yan X; Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville., Lou XY; Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville., Fernandez R; Department of Emergency Medicine and the Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville., Lion KC; Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky.; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	JAMA pediatrics [JAMA Pediatr] 2024 Jan 01; Vol. 178 (1), pp. 55-64.
DOI:	10.1001/jamapediatrics.2023.4890
Abstrakt:	Importance: Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. Objective: To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. Design, Setting, and Participants: This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Exposures: Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). Main Outcomes and Measures: The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Results: Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Conclusions and Relevance: Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.
Databáze:	MEDLINE
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