Department of Emergency Medicine, University of Florida College of Medicine, Gainesville.
Department of Pediatrics, University of Florida College of Medicine, Gainesville.
JAMA Pediatr. 2024 Jan 1;178(1):55-64. doi: 10.1001/jamapediatrics.2023.4890.
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.
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.
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).
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.
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).
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.
患有发热且低风险侵袭性细菌感染的婴儿不太可能从腰椎穿刺、抗生素或住院治疗中获益，但这些治疗方法通常会被采用。目前尚不清楚种族、民族或语言是否会影响治疗方法的选择。
研究种族、民族和语言与低风险侵袭性细菌感染的外观良好的发热婴儿的额外干预措施（腰椎穿刺、经验性抗生素和住院治疗）之间的关联。
设计、地点和参与者：这是一项多中心回顾性横断面分析，研究对象为 2018 年 1 月 1 日至 2019 年 12 月 31 日期间在急诊科接受治疗的婴儿。数据分析于 2023 年 12 月进行。儿科急诊通过儿科急诊医学合作研究委员会确定。纳入的研究对象为年龄在 29 至 60 天、基于血液和尿液检测低风险侵袭性细菌感染且外观良好的婴儿。共纳入了 9847 名婴儿，排除了外观不佳、病史和局灶性感染源诊断后，最终有 4042 名婴儿纳入研究。
婴儿种族和民族（非西班牙裔黑人、西班牙裔、非西班牙裔白人及其他种族或民族）和用于医疗的语言（英语和非英语）。
主要结局是接受至少 1 项非指征性干预措施，包括腰椎穿刺、经验性抗生素或住院治疗。我们进行了二元和多变量逻辑回归分析，并进行了总和对比。个体成分作为次要结局进行评估。
在 34 个地点中，共有 4042 名婴儿（中位数[IQR]年龄为 45[38-53]天；1561 名[3516 名无缺失性别婴儿中的 44.4%]为女性；612 名[15.1%]为非西班牙裔黑人，1054 名[26.1%]为西班牙裔，1741 名[43.1%]为非西班牙裔白人，352 名[9.1%]为其他种族或民族；3555 名[88.0%]为英语，463 名[12.0%]为非英语）符合纳入标准。主要结局发生在 969 名婴儿（24%）中。种族和民族与主要复合结局无关。与总体平均值相比，使用非英语的家庭的婴儿发生主要结局的可能性更高（调整后的优势比[aOR]，1.16；95%CI，1.01-1.33）。在次要分析中，与总体平均值相比，西班牙裔婴儿住院的可能性较低（aOR，0.76；95%CI，0.63-0.93）。与总体平均值相比，使用非英语的家庭的婴儿住院的可能性更高（aOR，1.08；95%CI，1.08-1.46）。
在低风险发热婴儿中，用于医疗的语言与至少 1 项非指征性干预措施的使用有关，但种族和民族没有关系。次要分析强调了种族、民族、语言和健康不平等之间的复杂相互关系。由于不平等的护理可能受到沟通障碍的影响，如果新的指南不特别关注公平性而仅强调以患者为中心的沟通，那么实施这些指南可能会造成新的差异。
