PHILADELPHIA – Black and Latino children are less likely than white children to receive medical imaging tests, such as ultrasounds, MRIs, and X-rays, during emergency department visits, said a study by researchers at UPMC Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.

The findings, published in JAMA Open Network, suggest an underuse of imaging among minority children and overuse among white children. Researchers attributed the disparity to a range of factors, including bias among doctors whose treatment decisions are influenced by patients' race.

"Something else is going on here that's beyond the clinical, that's beyond the diagnoses," said Jennifer Marin, an associate professor of pediatrics, emergency medicine, and radiology and the study's lead author.

Researchers studied billing data for more than 13 million emergency department visits among children at 52 hospitals in 27 states and the District of Columbia between 2016 and 2019. Even after controlling for factors such as insurance coverage, household income, and diagnosis, researchers found emergency departments ordered far fewer imaging tests for Black and Latino children, compared with white children:

• Black children were 18% less likely than white children to receive medical imaging as part of their visit.

• Latino children were 13% less likely than white children to receive imaging tests.

Marin said there are several factors that could be contributing to the gap, such as heightened anxiety and demand for testing among white parents, language barriers that result in more or less testing among Latino children, and implicit bias among doctors.

Implicit bias is when a doctor's medical decisions are influenced by unconscious attitudes, beliefs, or stereotypes about people of different races and ethnicity.

One limitation of the study is that data cannot show how sick children were when they arrived at the emergency department. But when researchers looked specifically at cases where the child had been discharged from the emergency department — meaning they were not sick enough to be admitted to the hospital — they found even larger racial gaps in testing.

"There's clearly a problem. It then becomes important for local emergency departments to look internally at their data," Marin said. "Really seeing that personalized data can be very eye-opening for physicians. … I think people would want to know if they're treating children differently just based on their race."