Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma

Pediatric Brain Injury Research Network (PediBIRN) Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. Study design: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. Results: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P <.001; aOR, 2.2) and reported (P =.001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P =.001 [aOR, 2.4] and P =.003 [aOR, 2.1]) or with an estimated AHT probability of ≤25% (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. Conclusion: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians’ implicit bias.

Original languageEnglish (US)
Pages (from-to)137-143.e1
JournalJournal of Pediatrics
Volume198
DOIs
StatePublished - Jul 1 2018

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Craniocerebral Trauma
Brain Injuries
Pediatrics
Research
Critical Care
Cross-Sectional Studies
Head
Physicians

Keywords

  • abusive head trauma
  • bias
  • child abuse
  • practice disparities

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma. / Pediatric Brain Injury Research Network (PediBIRN) Investigators.

In: Journal of Pediatrics, Vol. 198, 01.07.2018, p. 137-143.e1.

Research output: Contribution to journalArticle

Pediatric Brain Injury Research Network (PediBIRN) Investigators. / Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma. In: Journal of Pediatrics. 2018 ; Vol. 198. pp. 137-143.e1.
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abstract = "Objective: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. Study design: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. Results: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P <.001; aOR, 2.2) and reported (P =.001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P =.001 [aOR, 2.4] and P =.003 [aOR, 2.1]) or with an estimated AHT probability of ≤25{\%} (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. Conclusion: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians’ implicit bias.",
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author = "{Pediatric Brain Injury Research Network (PediBIRN) Investigators} and Hymel, {Kent P.} and Laskey, {Antoinette L.} and Crowell, {Kathryn R.} and Ming Wang and Veronica Armijo-Garcia and Frazier, {Terra N.} and Tieves, {Kelly S.} and Robin Foster and Kerri Weeks and Hymel, {Kent P.} and Dias, {Mark S.} and Halstead, {E. Scott} and Ming Wang and Chinchilli, {Vernon M.} and Bruce Herman and Robin Foster and Willson, {Douglas R.} and Mark Marinello and Veronica Armijo-Garcia and Narang, {Sandeep K.} and Natalie Kissoon and Pullin, {Deborah A.} and Gautham Suresh and Karen Homa and Graf, {Jeanine M.} and Reena Isaac and Matthew Musick and Frazier, {Terra N.} and Tieves, {Kelly S.} and Carroll, {Christopher L.} and Truemper, {Edward J} and Haney, {Suzanne B.} and Kerri Meyer and Smith, {Lindall E.} and Higgerson, {Renee A.} and Edwards, {George A.} and Harper, {Nancy S.} and Serrao, {Karl L.} and Andrew Sirotnak and Joseph Albietz and Antonia Chiesa and Boos, {Stephen C.} and Christine McKiernan and Michael Stoiko and Debra Simms and Brown, {Sarah J.} and Amy Ornstein and Phil Hyden and Lorenz, {Douglas J.} and Karst, {Wouter A.}",
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T1 - Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma

AU - Pediatric Brain Injury Research Network (PediBIRN) Investigators

AU - Hymel, Kent P.

AU - Laskey, Antoinette L.

AU - Crowell, Kathryn R.

AU - Wang, Ming

AU - Armijo-Garcia, Veronica

AU - Frazier, Terra N.

AU - Tieves, Kelly S.

AU - Foster, Robin

AU - Weeks, Kerri

AU - Hymel, Kent P.

AU - Dias, Mark S.

AU - Halstead, E. Scott

AU - Wang, Ming

AU - Chinchilli, Vernon M.

AU - Herman, Bruce

AU - Foster, Robin

AU - Willson, Douglas R.

AU - Marinello, Mark

AU - Armijo-Garcia, Veronica

AU - Narang, Sandeep K.

AU - Kissoon, Natalie

AU - Pullin, Deborah A.

AU - Suresh, Gautham

AU - Homa, Karen

AU - Graf, Jeanine M.

AU - Isaac, Reena

AU - Musick, Matthew

AU - Frazier, Terra N.

AU - Tieves, Kelly S.

AU - Carroll, Christopher L.

AU - Truemper, Edward J

AU - Haney, Suzanne B.

AU - Meyer, Kerri

AU - Smith, Lindall E.

AU - Higgerson, Renee A.

AU - Edwards, George A.

AU - Harper, Nancy S.

AU - Serrao, Karl L.

AU - Sirotnak, Andrew

AU - Albietz, Joseph

AU - Chiesa, Antonia

AU - Boos, Stephen C.

AU - McKiernan, Christine

AU - Stoiko, Michael

AU - Simms, Debra

AU - Brown, Sarah J.

AU - Ornstein, Amy

AU - Hyden, Phil

AU - Lorenz, Douglas J.

AU - Karst, Wouter A.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objective: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. Study design: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. Results: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P <.001; aOR, 2.2) and reported (P =.001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P =.001 [aOR, 2.4] and P =.003 [aOR, 2.1]) or with an estimated AHT probability of ≤25% (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. Conclusion: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians’ implicit bias.

AB - Objective: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. Study design: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. Results: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P <.001; aOR, 2.2) and reported (P =.001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P =.001 [aOR, 2.4] and P =.003 [aOR, 2.1]) or with an estimated AHT probability of ≤25% (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. Conclusion: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians’ implicit bias.

KW - abusive head trauma

KW - bias

KW - child abuse

KW - practice disparities

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