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. 2024 Jan 1;178(1):55-64.
doi: 10.1001/jamapediatrics.2023.4890.

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Colleen K Gutman  1   2 , Paul L Aronson  3   4 , Nidhi V Singh  5 , Michelle L Pickett  6 , Kamali Bouvay  7 , Rebecca S Green  8   9 , Britta Roach  10 , Hannah Kotler  11 , Jessica L Chow  12   13 , Emily A Hartford  14 , Mark Hincapie  15   16 , Ryan St Pierre-Hetz  15 , Jessica Kelly  9 , Laura Sartori  9 , Jennifer A Hoffmann  17 , Jacqueline B Corboy  17 , Kelly R Bergmann  18 , Bolanle Akinsola  19 , Vanessa Ford  19 , Natalie J Tedford  20 , Theresa T Tran  20 , Sasha Gifford  21   22 , Amy D Thompson  23 , Andrew Krack  24 , Mary Jane Piroutek  25 , Samantha Lucrezia  26 , SunHee Chung  27   28 , Nabila Chowdhury  29 , Kathleen Jackson  30 , Tabitha Cheng  31 , Christian D Pulcini  32   33 , Nirupama Kannikeswaran  34 , Larissa L Truschel  35 , Karen Lin  35 , Jamie Chu  36   37 , Neh D Molyneaux  36 , Myto Duong  38 , Leslie Dingeldein  39 , Jerri A Rose  39 , Carly Theiler  40 , Sonali Bhalodkar  3   4 , Emily Powers  3   4 , Muhammad Waseem  41   42 , Ahmed Lababidi  1   2 , Xinyu Yan  43 , Xiang-Yang Lou  43 , Rosemarie Fernandez  44 , K Casey Lion  26   45
Affiliations

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Colleen K Gutman et al. JAMA Pediatr. .

Abstract

Importance: 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.

Objective: 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.

Exposures: 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).

Main outcomes and measures: 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.

Results: 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).

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Gutman and Lou reported grants from National Center for Advancing Translational Sciences during the conduct of the study. Dr Tedford reported grants from the American Academy of Pediatrics CATCH Program and the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Inclusion and Exclusion Flow Diagram
Total is greater than the sample size as infants could meet more than 1 exclusion criteria within that exclusion category.
See this image and copyright information in PMC

Comment in

References

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