The first large study of more than 13 million visits to 44 pediatric emergency departments (ED) found that Black and Latinx children were less likely to receive x-rays, CT, ultrasound, and MRI compared with white children. These findings, published in JAMA Network Open, were consistent across most diagnostic groups and persisted when stratified by public or private insurance type.

“Our findings suggest that a child’s race and ethnicity may be independently associated with the decision to perform imaging during ED visits,” says co-author Elizabeth Alpern, MD, MSCE, division head of emergency medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Northwestern University Feinberg School of Medicine.

“Since our study analyzed only administrative data and not patient-specific clinical data, we do not know if our findings are indicative of overuse of imaging in white patients or underuse in Black and Latinx patients. We need further research to understand the causes of the disparities we observed so we can plan measurable interventions to ensure that each individual child receives the right care based on medical needs.”

Alpern and colleagues observed that imaging was performed in over 33% of emergency visits by white patients compared with 24% of visits by Black patients and 26% of visits by Latinx patients. Visits by Black and Latinx children were less likely than those by white children to include any imaging.

Previous research has highlighted imaging overuse among white children, with no differences in clinical outcomes. For example, other studies have shown that compared with non-white children, white children have higher rates of advanced imaging for abdominal pain and abdominal trauma, as well as chest radiographs for bronchiolitis, asthma, and chest pain.

“Both overuse and underuse of diagnostic imaging are concerning,” says Alpern. “Overuse may expose children to unnecessary risks associated with imaging, while underuse may result in misdiagnoses, need for further care and potentially worse clinical outcomes. Evidence-based guidelines for pediatric imaging are currently in development, and their implementation may help eliminate racial and ethnic disparities and allow for more equitable and improved care for children.”