Purpose or Case Report: To assess whether a pediatric patient’s race or ethnicity influences the likelihood of receiving a skeletal survey (CPT 77075/77076) during initial ED evaluation for suspected physical abuse, using Nationwide Emergency Department Sample (NEDS) database. This analysis was conducted in the context of Variant 1 of the ACR Appropriateness Criteria® for Suspected Physical Abuse in Children, which recommends skeletal survey as the appropriate initial imaging evaluation in such cases.
Methods & Materials: We analyzed 2019–2022 NEDS data for patients aged 0–2 years with a diagnosis of suspected child physical abuse (ICD-10 T76.12XA). Continuous variables were summarized using means ± SD or medians (IQR), and categorical variables compared using Chi-square tests. Age differences across racial groups were assessed using a survey-weighted generalized linear model with a Gamma distribution and log link. Logistic regression models estimated unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), controlling for age, income quartile, and hospital characteristics. Analyses incorporated population discharge weights, with two-sided p<0.05 considered significant. All analyses were performed using SAS 9.4 and STATA 19.
Results: From 2019–2022, 26,042 ED visits for suspected physical abuse among children aged 0–2 years were identified in NEDS. The cohort was 51.6% White, 21.5% Black, 20.1% Hispanic, 1.3% Asian, 0.9% Native American, and 4.6% Other, with a mean age of 0.73 ± 0.86 years (p = 0.39 across groups).

A skeletal survey was performed in 32.8% of cases, varying by race (p = 0.05): White (35.2%), Black (32.2%), Hispanic (29.4%), Asian (30.8%), Native American (31.8%), and Other (24.7%).

In unadjusted analyses, minority groups had lower odds of skeletal survey compared with White children, although statistical significance was only reached for those categorized as Other (OR = 0.61, 95% CI 0.43–0.86, p = 0.005). After adjustment for demographic and hospital factors, Black (aOR = 0.83, 95% CI 0.69–0.99, p = 0.04) and Other (aOR = 0.67, 95% CI 0.48–0.93, p = 0.02) children remained significantly less likely to receive a skeletal survey.
Conclusions: Skeletal surveys were performed in only one-third of suspected abuse cases, reflecting significant underutilization despite ACR recommendations. Black and Other race children were less likely than White children to receive a survey, highlighting the need for greater adherence to guidelines and equitable evaluation practices.