{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:07:42Z","timestamp":1792026462766,"version":"4.4.0"},"reference-count":67,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-poi230074-4\"><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-5\"><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-7\"><jats:title>Exposures<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-9\"><jats:title>Results<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230074-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2023.4890","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T16:01:22Z","timestamp":1699891282000},"page":"55","source":"Crossref","is-referenced-by-count":33,"title":["Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants"],"prefix":"10.1001","volume":"178","author":[{"given":"Colleen K.","family":"Gutman","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Florida College of Medicine, Gainesville"},{"name":"Department of Pediatrics, University of Florida College of Medicine, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi V.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Pickett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamali","family":"Bouvay","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children\u2019s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca S.","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School and Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"Roach","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Kotler","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, The George Washington University School of Medicine and Health Sciences and Children\u2019s National Health System, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Chow","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"},{"name":"Department of Emergency Medicine, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Hartford","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington School of Medicine and Seattle Children\u2019s Hospital, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hincapie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pittsburgh Medical Center and Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Division of Pediatric Emergency Medicine, Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"St. Pierre-Hetz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pittsburgh Medical Center and Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sartori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ann & Robert H. 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