In Reply We thank Cruz et al, Shaw et al, and Goza for their thoughtful response letters to our Viewpoint1 and this opportunity for important dialogue. We have great respect for the authors of these letters and their significant contributions to the field of pediatric emergency medicine.
It is critical to study race as a social determinant of health. However, situating it as a decision node in a guideline, requires discerning consideration. The JAMA User’s Guide to the Medical Literature states that guidelines “reflect value judgements about the relative importance of various health and economic outcomes” 2and emphasizes that “they should be required to pass unique tests about how matters of opinion, in addition to matters of science, are handled.”2 Historically, when race has appeared in a pediatric guideline, it has been positioned to ensure equitable care for high risk groups.3 However, this is not the case in the American Academy of Pediatrics (AAP) urinary tract infection (UTI) guideline, which systematically indicates differential care for black or nonwhite children based on a theoretical lower risk of UTI.4 Foundational studies conducted 20 years ago on the prevalence of UTI generated important information. However, we submit that framing these early findings as knowledge has led to fraught construct validity and uncertain applicability to children in the 21st century.
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Kowalsky RH, Rondini AC, Platt SL. Perspectives on Urinary Tract Infection and Race. JAMA Pediatr. Published online July 06, 2020. doi:10.1001/jamapediatrics.2020.1162
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