Potential Racial Bias During Pediatric Emergency Care: A Simulation Study

TL;DR

This study used high-fidelity simulations to find racial bias in pediatric emergency care decisions, showing differences in treatment based on manikin skin color.

Contribution

The study introduces high-fidelity simulation as a novel method to detect implicit racial bias in pediatric emergency care.

Findings

Dark-skinned infants were more likely to receive oxygen than light-skinned infants.

Light-skinned infants were more likely to receive compressions after asystole compared to dark-skinned infants.

Abstract

Objectives

Despite education to help reduce differences in care, minorities continue to have worse health outcomes. Implicit biases are known to contribute to disparities in healthcare, even in pediatric populations. Prior simulation studies have used computer simulations or standardized patient encounters to understand the potential role of implicit bias in patient interactions. High-fidelity simulation is another method for evaluating patient management decisions in a controlled environment. This study aimed to evaluate whether high-fidelity simulation could reveal differences in pediatric patient management decisions during an emergency based on the skin color of a pediatric manikin.

Methods

A standard simulation scenario was created for a pediatric sepsis case. Nineteen first-year pediatric residents in their first month of internship were offered the opportunity to participate, and informed consent was obtained for our study approved by CHRISTUS Health. Participants were not made aware that the study involved any evaluation related to manikin skin color. Enrolled participants were randomized to run through the scenario with either a dark or light skin manikin with a standardized patient of the same skin tone playing the role of the parent. After simulations were completed, videos were analyzed by physician graders with a standardized evaluation form documenting interventions and timing.

Results

The majority of care was not statistically different for both light- and dark-skinned manikins in the sepsis simulation. However, there were some significant differences noted. All of the dark-skinned infants received oxygen while only 55.5% (5/9) of the light-skinned infants received oxygen (p = 0.03). Additionally, 89% (8/9) of the light-skinned infants received compressions after asystole occurred while only 40% (4/10) of the dark-skinned infants received compressions (p = 0.05).

Discussion

In a simulated pediatric sepsis case, there were significant differences in some interventions on the basis of skin color. While we can only theorize about the reason for these, they may have resulted from assumptions of different etiologies of the emergencies or unconscious reactions to the color of the manikin. Simulation is a unique approach to evaluate this important topic using standardized simulations and evaluation tools, and we intend to use these results to hone further research investigating reasons for the identified differences.

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