Orthopaedic Diagnoses in the Black Pediatric Population

Abstract

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care. D r. Martin Luther King Jr. stated that "of all forms of inequity, injustice in health care is the most shocking and inhumane." 1 Differences in care exist at all levels of the healthcare delivery system based on socioeconomic status and race. Access to primary care, treatment in the emergency department, and hospital treatment have all been found to have racial discrepancies, with Black children most commonly ending up with less care and poorer quality of care. 2 In the emergency department, patient race can affect analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient experiences. 3 One particularly problematic area is in the treatment of pain. Opioid treatment of pain in adolescents has been found to favor treating non-Hispanic White patients over minorities. A study by Phan et al 2 demonstrated variability in treating pain based on race for the same diagnoses. These trends persist into adulthood, with pain in the Black population being ignored or undertreated across fields and through the end of life. Extensive work has been done in the past 5 years looking at persistent racial disparities in pediatric surgical outcomes and anesthesia. 4 Variability in surgical outcome has previously been attributed to baseline preoperative characteristics. Recent studies demonstrate that even when controlling for American Society of Anesthesiologists (ASA) scores, Black children have