. 2018 Jul:198:137-143.e1.

doi: 10.1016/j.jpeds.2018.01.048. Epub 2018 Mar 29.

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

Kent P Hymel¹, Antoinette L Laskey², Kathryn R Crowell³, Ming Wang⁴, Veronica Armijo-Garcia⁵, Terra N Frazier⁶, Kelly S Tieves⁶, Robin Foster⁷, Kerri Weeks⁸; Pediatric Brain Injury Research Network (PediBIRN) Investigators

Collaborators, Affiliations

Collaborators

Pediatric Brain Injury Research Network (PediBIRN) Investigators:
Kent P Hymel⁹, Mark S Dias⁹, E Scott Halstead⁹, Ming Wang⁹, Vernon M Chinchilli⁹, Bruce Herman¹⁰, Robin Foster¹¹, Douglas R Willson¹¹, Mark Marinello¹¹, Veronica Armijo-Garcia¹², Sandeep K Narang¹², Natalie Kissoon¹², Deborah A Pullin¹³, Gautham Suresh¹³, Karen Homa¹³, Jeanine M Graf¹⁴, Reena Isaac¹⁴, Matthew Musick¹⁴, Terra N Frazier¹⁵, Kelly S Tieves¹⁵, Christopher L Carroll¹⁶, Edward Truemper¹⁷, Suzanne B Haney¹⁷, Kerri Meyer¹⁸, Lindall E Smith¹⁸, Renee A Higgerson¹⁹, George A Edwards¹⁹, Nancy S Harper²⁰, Karl L Serrao²⁰, Andrew Sirotnak²¹, Joseph Albietz²¹, Antonia Chiesa²¹, Stephen C Boos²², Christine McKiernan²², Michael Stoiko²³, Debra Simms²³, Sarah J Brown²³, Amy Ornstein²⁴, Phil Hyden²⁵, Douglas J Lorenz²⁶, Wouter A Karst²⁷

Affiliations

¹ Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA. Electronic address: kphymel@gmail.com.
² Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT.
³ Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA.
⁴ Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
⁵ Department of Pediatrics, University of Texas Health Sciences Center San Antonio, San Antonio, TX.
⁶ Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
⁷ Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA.
⁸ Department of Pediatrics, University of Kansas School of Medicine, Wichita, KS.
⁹ Penn State Health Children's Hospital and College of Medicine, Hershey, PA.
¹⁰ Primary Children's Medical Center, Salt Lake City, UT.
¹¹ The Children's Hospital of Richmond.
¹² University of Texas Health Sciences Center at San Antonio, San Antonio, TX.
¹³ Dartmouth-Hitchcock Medical Center, Lebanon, NH.
¹⁴ Texas Children's Hospital, Houston, TX.
¹⁵ Children's Mercy Hospital, Kansas City, MO.
¹⁶ Connecticut Children's Medical Center, Hartford, CT.
¹⁷ Children's Hospital of Omaha, Omaha, NE.
¹⁸ Wesley Medical Center, Wichita, KS.
¹⁹ Dell Children's Medical Center of Central Texas, Austin, TX.
²⁰ Driscoll Children's Hospital, Corpus Christi, TX.
²¹ Children's Hospital Colorado, Denver, CO.
²² Baystate Medical Center, Springfield, MA.
²³ Helen DeVos Children's Hospital, Grand Rapids, MI.
²⁴ IWK Health Centre, Halifax, Nova Scotia.
²⁵ Children's Hospital of Central California, Madera, CA.
²⁶ University of Louisville School of Public Health and Information Sciences, Louisville, KY.
²⁷ Netherlands Forensic Institute, The Hague, The Netherlands.

PMID: 29606408
PMCID: PMC7243470
DOI: 10.1016/j.jpeds.2018.01.048

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

Kent P Hymel et al. J Pediatr. 2018 Jul.

. 2018 Jul:198:137-143.e1.

doi: 10.1016/j.jpeds.2018.01.048. Epub 2018 Mar 29.

Authors

Collaborators

Pediatric Brain Injury Research Network (PediBIRN) Investigators:
Kent P Hymel⁹, Mark S Dias⁹, E Scott Halstead⁹, Ming Wang⁹, Vernon M Chinchilli⁹, Bruce Herman¹⁰, Robin Foster¹¹, Douglas R Willson¹¹, Mark Marinello¹¹, Veronica Armijo-Garcia¹², Sandeep K Narang¹², Natalie Kissoon¹², Deborah A Pullin¹³, Gautham Suresh¹³, Karen Homa¹³, Jeanine M Graf¹⁴, Reena Isaac¹⁴, Matthew Musick¹⁴, Terra N Frazier¹⁵, Kelly S Tieves¹⁵, Christopher L Carroll¹⁶, Edward Truemper¹⁷, Suzanne B Haney¹⁷, Kerri Meyer¹⁸, Lindall E Smith¹⁸, Renee A Higgerson¹⁹, George A Edwards¹⁹, Nancy S Harper²⁰, Karl L Serrao²⁰, Andrew Sirotnak²¹, Joseph Albietz²¹, Antonia Chiesa²¹, Stephen C Boos²², Christine McKiernan²², Michael Stoiko²³, Debra Simms²³, Sarah J Brown²³, Amy Ornstein²⁴, Phil Hyden²⁵, Douglas J Lorenz²⁶, Wouter A Karst²⁷

Affiliations

¹ Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA. Electronic address: kphymel@gmail.com.
² Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT.
³ Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA.
⁴ Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
⁵ Department of Pediatrics, University of Texas Health Sciences Center San Antonio, San Antonio, TX.
⁶ Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
⁷ Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA.
⁸ Department of Pediatrics, University of Kansas School of Medicine, Wichita, KS.
⁹ Penn State Health Children's Hospital and College of Medicine, Hershey, PA.
¹⁰ Primary Children's Medical Center, Salt Lake City, UT.
¹¹ The Children's Hospital of Richmond.
¹² University of Texas Health Sciences Center at San Antonio, San Antonio, TX.
¹³ Dartmouth-Hitchcock Medical Center, Lebanon, NH.
¹⁴ Texas Children's Hospital, Houston, TX.
¹⁵ Children's Mercy Hospital, Kansas City, MO.
¹⁶ Connecticut Children's Medical Center, Hartford, CT.
¹⁷ Children's Hospital of Omaha, Omaha, NE.
¹⁸ Wesley Medical Center, Wichita, KS.
¹⁹ Dell Children's Medical Center of Central Texas, Austin, TX.
²⁰ Driscoll Children's Hospital, Corpus Christi, TX.
²¹ Children's Hospital Colorado, Denver, CO.
²² Baystate Medical Center, Springfield, MA.
²³ Helen DeVos Children's Hospital, Grand Rapids, MI.
²⁴ IWK Health Centre, Halifax, Nova Scotia.
²⁵ Children's Hospital of Central California, Madera, CA.
²⁶ University of Louisville School of Public Health and Information Sciences, Louisville, KY.
²⁷ Netherlands Forensic Institute, The Hague, The Netherlands.

PMID: 29606408
PMCID: PMC7243470
DOI: 10.1016/j.jpeds.2018.01.048

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.

Keywords: abusive head trauma; bias; child abuse; practice disparities.

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Figures

**Figure 1.**
Comparisons of AHT evaluation and reporting practices in white/non-Hispanic vs minority race/ethnicity patients across all 18 participating sites.

**Figure 2.**
Comparisons of AHT evaluation and reporting practices in white/non-Hispanic vs minority race/ethnicity patients at the 2 sites with confirmed AHT-related practice disparities.

**Figure 3.**
Comparisons of AHT evaluation and reporting practices in white/non-Hispanic vs minority race/ethnicity patients at the remaining 16 sites.

See this image and copyright information in PMC

Comment in

Bias and Objectivity When Evaluating Social Risk Factors for Physical Abuse: of Babies and Bathwater.
Lindberg DM. Lindberg DM. J Pediatr. 2018 Jul;198:13-15. doi: 10.1016/j.jpeds.2018.02.010. Epub 2018 Mar 15. J Pediatr. 2018. PMID: 29551314 Free PMC article. No abstract available.

References

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1. Johnson TJ, Winger DG, Hickey RW, Switzer GE, Miller E, Nguyen MB, et al. Comparison of physician implicit racial bias toward adults versus children. Acad Pediatr 2017;17:120–6. - PMC - PubMed
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Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical