A scoping review of research on potential impact of implicit bias in healthcare settings for children with acquired brain injuries.
Jiabin Shen, Amanda Carmichael, Alexander J Clinton
PMID 37796578WHAT IT FOUND
Three studies of children under three with brain injuries found racial disparities in how suspected abuse was evaluated.
Minority children were screened more often for abuse, while white children’s abuse was missed more often. This suggests provider bias may affect diagnosis.
Key findings
01All three included studies found racial and ethnic disparities in provider-patient interactions that may influence the evaluation of pediatric acquired brain injury.
02In one study, minority children were more commonly evaluated and reported for suspected physical abuse than white/non-Hispanic children, particularly in lower-risk cases.
03In another study, abusive head trauma was missed in 37.4% of white children compared to 11% of minority children, and missed cases allowed for reinjury due to delay.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only three studies were included, all focusing on children under three years old with suspected abusive head trauma, so findings do not apply to older children or other causes of acquired brain injury. None of the included studies directly measured implicit bias; they only showed associations between race and clinical decisions, so the role of unconscious provider beliefs is inferred rather than proven. The review did not include quantitative synthesis or meta-analysis due to the small number of studies. The studies varied in design, including retrospective chart reviews and one interventional study, which limits the ability to draw firm conclusions about causality.
Declared interests
The authors declared no conflicts of interest. The study was not funded by a commercial entity, and the search protocol was not pre-registered.
The easy way to misread this
Do not conclude that implicit bias was directly measured or proven to cause these disparities. The included studies showed associations between race and clinical decisions, but none used tools like the Implicit Association Test to measure provider bias directly, so other factors like insurance status or family structure may also explain the differences.