Social Factors Associated with Ultrasound Versus Computed Tomography Utilization Among Children Diagnosed with Pyelonephritis in the Emergency Department.

RATIONALE AND

OBJECTIVES

Acute pyelonephritis can complicate lower urinary tract infections (UTI) in children. While often unnecessary, imaging may be helpful if clinical symptomatology is atypical or complications are suspected. As social determinants of health (SDoH) can impact care, this study examines the correlational relationship between SDoH and computed tomography (CT) versus ultrasound (US) when imaging is used in pediatric patients with pyelonephritis in the emergency department.

MATERIALS AND

METHODS

A multivariate logistic regression analysis was performed using data from the Nationwide Emergency Department Sample (NEDS), including pediatric patients with acute pyelonephritis (ICD-10: N10) who received CT or US in 2019-2020.

RESULTS

Of the 39,528 patients diagnosed with pyelonephritis, 6240 patients received imaging with either CT (74%) or US (26%). Children >3 years old were significantly less likely to receive an US versus CT (p < 0.01). Patients from zip codes of median household incomes ≥$82,000 were twice as likely to receive an US (p = 0.024). US was more frequently used at level I trauma centers (OR: 4.45, p < 0.001) and metropolitan teaching hospitals (OR: 1.76, p = 0.05).

CONCLUSION

Among children undergoing CT or US in the emergency department with an eventual diagnosis of pyelonephritis, CT is more often utilized for older patients, those from lower income zip codes, and those imaged at non-teaching hospitals. Further efforts should focus on minimizing radiation exposure as well as recognition of possible barriers to care and SDoH when imaging is associated with the diagnosis of pediatric pyelonephritis.