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Racial Differences in Urine Testing of Febrile Young Children Presenting to Pediatric Hospitals

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Dating back to 2011, practice guidelines considered Black race a factor associated with lower risk of urinary tract infection (UTI). Race-based clinical decisions raise concerns about potential treatment disparities. We investigate urine testing (urinalysis and/or urine culture) among young febrile children in the emergency department (ED), revisits, and potential missed diagnoses by race/ethnicity.

Methods

We performed a multicenter retrospective cohort study of children 2–24 months evaluated in 26 US EDs from 2009 to 2019 with a fever diagnosis. We evaluated longitudinal testing trends, constructed a generalized linear mixed-effects model to identify the association of race/ethnicity with testing, and characterized UTI diagnoses and ≤ 7-day revisits.

Results

Of 734,730 included patients, 24.1% were Black. Variation in urine testing was observed by patient race/ethnicity (23.4% Black, 31.7% White, 33.9% Hispanic, 30.0% other race). Relative differences in testing persisted over time. Black patients had lower adjusted odds of testing (0.70, 95% confidence interval [CI] 0.69–0.71). Among patients with urine testing, 2.4% (95% CI 2.3–2.6%) of Black and 3.3% (95% CI 3.1–3.4%) of White patients were diagnosed with UTI. Among Black patients with urine testing on the index visit, 8.5% (95% CI 8.2–8.8%) had return visits compared to 7.6% (95% CI 7.5–7.8%) among those without urine testing on index visit. Among patients with urine testing on revisit, UTI diagnosis was similar by race/ethnicity.

Conclusion

Black patients had lower rates of urine testing and UTI diagnoses relative to other racial/ethnic groups. This was not associated with higher rates of missed diagnoses or unscheduled return visits.

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Data Availability

Data provided to this study by the Children’s Hospital Association (Overland Park, KS) are available to member hospitals which contribute data to the Pediatric Health Information System.

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Funding

Dr. Ramgopal is sponsored by PEDSnet (Department of Pediatris, Ann and Robert H Lurie Children’s Hospital of Chicago). All others have no funding sources to disclose.

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Authors and Affiliations

  1. Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sriram Ramgopal, Nichell Tidwell & Michelle L. Macy

  2. Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Box 62, Chicago, IL, 60611, USA

    Sriram Ramgopal

  3. Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Nader Shaikh

  4. Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Timothy R. Shope

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  1. Sriram Ramgopal
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Contributions

Dr. Ramgopal conceptualized and designed the study, performed the analysis, and drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Tidwell, Shaikh, Shope, and Macy designed the study, interpreted results, and reviewed and revised the manuscript for intellectually important content. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sriram Ramgopal.

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Conflict of Interest

The authors declare no competing interests.

Ethics Approval

This study was considered exempt by the Institutional Review Board of the Ann and Robert H Lurie Children’s Hospital of Chicago.

Research Involving Human Participants

This study reports on research involving human subjects using a de-identified dataset.

Informed Consent

This study was considered exempt from the requirement of informed consent by the Institutional Review Board of the Ann and Robert H Lurie Children’s Hospital of Chicago (IRB# 2021-4398).

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Supplementary Information

Supplementary Table 1

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Supplementary Table 2

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Supplementary Table 3

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Supplementary Table 4

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Supplementary Table 5

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Supplementary Table 6

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Supplementary Figure

Percent of urine testing performed among included children and stratified into race/ethnicity groups of Black and non-Black by hospital. (PNG 4456 kb)

High resolution image (TIF 909 kb)

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Ramgopal, S., Tidwell, N., Shaikh, N. et al. Racial Differences in Urine Testing of Febrile Young Children Presenting to Pediatric Hospitals. J. Racial and Ethnic Health Disparities 9, 2468–2476 (2022). https://doi.org/10.1007/s40615-021-01182-6

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  • DOI: https://doi.org/10.1007/s40615-021-01182-6

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