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Pediatr Emerg Care. 2019 Nov 8. doi: 10.1097/PEC.0000000000001945. [Epub ahead of print]

Patient Ethnicity and Pediatric Visits to the Emergency Department for Fever.

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From the Department of Pediatrics, Boston Children's Hospital.
Division of Emergency Medicine, Boston Children's Hospital.
Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.



Previous research has identified ethnic differences in parents' beliefs about fever, but whether patient ethnicity is associated with health care use for fever is uncertain. Our objectives were to describe the national rate of pediatric visits to the emergency department (ED) for fever and to determine whether there is variation in this rate by patient ethnicity.


Using the National Hospital Ambulatory Medical Care Survey between 2012 and 2015, we estimated the proportion of ED visits with a complaint of fever by patients 0 to 18 years old and compared this proportion across patient ethnicity. We performed multivariable logistic regression controlling for sociodemographic characteristics and visit acuity to determine whether patient ethnicity was independently associated with visits for fever.


Fever was the reason for 19% [95% confidence interval (CI), 18%-20%] of pediatric visits to the ED, and the proportion of visits for fever was highest among Hispanic patients (25%; 95% CI, 23%-27%) and lowest among non-Hispanic white patients (15%; 95% CI, 14%-17%). In multivariable analysis, the adjusted odds of visits for fever were greater for Hispanic patients (odds ratio, 1.56; 95% CI, 1.38-1.83) and non-Hispanic non-black patients of other races (1.34; 95% CI, 1.02-1.77) compared with non-Hispanic white patients.


There is significant ethnic variation in the use of emergency medical services for fever in the United States, and these disparities are not fully explained by differences in the acuity of illness or differences in socioeconomic status. Interventions to empower parents to manage nonurgent pediatric fever should incorporate ethnocultural differences in parents' understanding of fever.

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