Social disparities in the use of diagnostic tests for children with gastroenteritis

Abstract

Objective: To determine whether patient demographic characteristics affect the use of diagnostic tests for the evaluation of children with acute gastroenteritis by emergency department ED) physicians. Design: Retrospective chart review. Setting: Emergency department of a tertiary care pediatric hospital. Sample: All patients seen in the emergency department over a six- month period with a discharge diagnosis of acute gastroenteritis (GE) as identified through a computerized patient log (n=503). Measures and analysis: Sociodemographic characteristics ('race' and insurance) were obtained from computerized hospital data. The number of tests ordered was identified from the medical records, as were indicators of illness severity. We utilized multivariate logistic regression using the generalized estimating equations (GEE) model to account for repeated visits and adjust for potential confounding. Results: Hispanic children were less likely to undergo more than two tests [OR.53 (95% CI.31,.92)] or have an X-ray done [OR.31 (95% CI 0.15, 0.67)], after adjustment for age and disease characteristics. Self-pay patients were less likely to have a test performed [OR.53 (95% CI3,.96)]. Conclusions: Some patient social characteristics remain associated with differing patterns of use of diagnostic tests for a common pediatric condition. Although this study provides no information on patient outcome, health providers should strive to reduce differences in care based on patient social and economic factors as distinct from characteristics of the patient's condition or medical need.