This episode of EM Pulse dives into a critical intersection of clinical practice: the overlap between objective evidence-based medicine and the subjective influence of implicit bias.

In a special collaboration with Don’t Forget the Bubbles (DFTB), we are joined by experts from across the globe to discuss a landmark study on how clinical decision rules—specifically the PECARN (Pediatric Emergency Care Applied Research Network) imaging rules—impact disparities in pediatric trauma imaging.

The Variables of Bias

The team explores the concept of equitable care—providing the best possible outcome regardless of factors outside a patient’s control—and why awareness alone often isn’t enough to counteract the biases we all carry.

Standardizing Equity: The Power of the Rule

The core of this discussion centers on a prospective multicenter study titled “Perceived Race and Ethnicity on CT Use in Children with Minor Head or Abdominal Trauma.”

The Question: Do racial and ethnic disparities in CT use still exist in the “PECARN era”?

The Twist: Why the researchers chose to look at clinician-perceived race rather than self-identification to capture what is actually happening in the provider’s mind during a shift.
The Finding: The guests discuss the encouraging results regarding how structured clinical rules can act as “equity builders.”

A Global Perspective

Bias isn’t just a local issue. With representation from UC Davis, UCSF, Children’s National, and Athens, Greece, the panel looks at the international landscape of pediatric emergency care. We discuss:

The barriers to implementing decision tools in different healthcare systems.
How these rules—originally developed in the U.S.—are being validated and adapted from Australia to Europe.

Our guests share how they envision these findings changing their next shift—not by removing the “humanity” of the process, but by anchoring conversations with families in solid evidence.

Check the Show Notes: We’ve included links to the original study and the companion blog post at Don’t Forget the Bubbles, which features a deep dive into the data. You can also find the PECARN Pediatric Head Injury and Intra-abdominal Injury (IAI) rules on MDCalc to use on your next shift.

We want to hear from you! Connect with us on social media @empulsepodcast or on our website ucdavisem.com.

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guests:

Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences

Dr. Nisa Atigapramoj, Pediatric Emergency Medicine Physician at UCSF Benioff Children’s Hospital

Dr. Spyridon Karageorgos, Pediatric Emergency Medicine Physician at Aghia Sophia Children’s’ Hospital in Athens, Greece

Resources:

DontForgetTheBubbles.com: CT Use in Children with Minor Head or Abdominal Trauma

Atigapramoj NS, McCarten-Gibbs K, Ugalde IT, Badawy M, Chaudhari PP, Yen K, Ishimine P, Sage AC, Nielsen D, Uppermann JS, Kravitz-Wirtz ND, Tancredi DJ, Holmes JF, Kuppermann N. Perceived Race and Ethnicity on CT Use in Children With Minor Head or Abdominal Trauma. Pediatrics. 2026 Feb 1;157(2):e2024070582. doi: 10.1542/peds.2024-070582. PMID: 41520991.

PECARN Spotlight: Tools Validated

Excuse Me, Your Bias is Showing

PECARN

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Do Clinical Decision Tools Reduce Bias? DFTB Collab