Use of Race in Pediatric Clinical Practice GuidelinesA Systematic Review

Question  How is race used in pediatric clinical practice guidelines?

Findings  In this systematic review including 126 pediatric clinical practice guidelines, race was frequently used in pediatric clinical practice guidelines in a way that could negatively affect health care inequities.

Meaning  The use of race in pediatric national guidelines should be improved to prevent the perpetuation of racial inequity and health care inequities.

Importance  National clinical practice guidelines (CPGs) guide medical practice. The use of race in CPGs has the potential to positively or negatively affect structural racism and health inequities.

Objective  To review the use of race in published pediatric CPGs.

Evidence Review  A literature search of PubMed, Medscape, Emergency Care Research Institute Guidelines Trust, and MetaLib.gov was performed for English-language clinical guidelines addressing patients younger than 19 years of age from January 1, 2016, to April 30, 2021. The study team systematically identified and evaluated all articles that used race and ethnicity terms and then used a critical race theory framework to classify each use according to the potential to either positively or negatively affect structural racism and racial inequities in health care.

Findings  Of 414 identified pediatric clinical practice guidelines, 126 (30%) met criteria for full review because of the use of race or ethnicity terms and 288 (70%) did not use race or ethnicity terms. The use of a race term occurred 175 times in either background, clinical recommendations, or future directions. A use of race with a potential negative effect occurred 87 times (49.7%) across 73 CPGs and a positive effect 50 times (28.6%) across 45 CPGs.

Conclusions and Relevance  In this systematic review of US-based pediatric CPGs, race was frequently used in ways that could negatively affect health care inequities. Many opportunities exist for national medical organizations to improve the use of race in CPGs to positively affect health care, particularly for racial and ethnic minoritized communities.