{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:54:25Z","timestamp":1790844865368,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infants with poor weight gain (PWG) are frequently hospitalized for evaluation and management. Diagnostic testing during hospitalization varies and may reflect practice variation and bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if diagnostic testing among infants hospitalized for PWG differed by community characteristics, as measured by the childhood opportunity index (COI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cross\u2010sectional study of children, ages 2 weeks\u201011 months, hospitalized with PWG at 43 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2022. COI, measured at the zip\u2010code level, was categorized into nationally normed quintiles. Logistic regression models estimated adjusted associations between COI and diagnostic testing, accounting for confounders defined a priori and clustering by hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to infants from very high COI communities, those from very low COI communities were more likely to receive screening tests like CBC (64.2% vs. 54.2%, adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.10, 1.35). In contrast, infants from very low COI communities were less likely to have diagnostic testing directed toward investigation of potentially specific medical etiologies, including upper gastrointestinal series (10.3% vs. 12.8%, aOR 0.67, 95% CI 0.56, 0.81). However, they were more likely to receive urine toxicology screening (1.5% vs. 0.6%, aOR 2.4, 95% CI 1.39, 4.14), suggestive of suspected neglect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This national study demonstrates community\u2010level variation in the diagnostic evaluation of infants hospitalized for PWG. While differences in psychosocial factors and healthcare access may contribute, these findings underscore the need to address potential bias in the care of infants with PWG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70505","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:54:54Z","timestamp":1790841294000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Community\u2010level variation in diagnostic testing in infants hospitalized for poor weight gain"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7434-1532","authenticated-orcid":false,"given":"Courtney","family":"Sump","sequence":"first","affiliation":[{"name":"Divisions of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5876-5335","authenticated-orcid":false,"given":"Margaret","family":"Ridge","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6528-6247","authenticated-orcid":false,"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Divisions of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9724-675X","authenticated-orcid":false,"given":"Bin","family":"Huang","sequence":"additional","affiliation":[{"name":"Divisions of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-7965","authenticated-orcid":false,"given":"Henry T.","family":"Puls","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City Kansas City Missouri USA"},{"name":"University of Missouri\u2010Kansas City School of Medicine Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4262-663X","authenticated-orcid":false,"given":"Andrew F.","family":"Beck","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"},{"name":"Divisions of General and Community Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7538-0998","authenticated-orcid":false,"given":"Joanna","family":"Thomson","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2015-0248"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2019.05.126"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/pir.21.8.257"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922817698803"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.57.5.347"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2018-0035"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2022-007038"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2023-007188"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.00735"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0679"},{"key":"e_1_2_9_12_1","unstructured":"What is child opportunity? | diversitydatakids.org. 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