Race/ethnicity differences examined in cranial CT among children

CHICAGO – According to a secondary analysis of a study of injured children, the odds of undergoing cranial computed tomography (CT) among children with minor blunt head trauma who were at higher risk for clinically important traumatic brain injury did not appear to differ by race/ethnicity. However, there may have been differences for children at intermediate or lowest risk.

The report appears in the August issue of Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

The study background reports that traumatic brain injury (TBI) is a leading cause of pediatric illness and death in the US. Each year, TBI is responsible for about 7,400 deaths, 60,000 hospital admissions, and more than 600,000 emergency department visits. Cranial CT is the standard of care for emergency diagnosis of TBI, but irradiation is associated with increased long-term risk for malignancies.

JoAnne E. Natale, M.D., Ph.D., of the University of California, Davis, Sacramento, headed the secondary analysis of a study conducted between June 2004 and September 2006 in a pediatric research network of 25 emergency departments. The children enrolled in the study were documented as white non-Hispanic, black non-Hispanic, or Hispanic.

Racial/ethnic disparities were observed by the researchers among children with the lowest risk or an intermediate risk of clinically important traumatic brain injury (ciTBI), with children of white non-Hispanic race/ethnicity more likely to undergo cranial CT. Children of black non-Hispanic or Hispanic race/ethnicity had lower odds of undergoing cranial CT among those of intermediate or lowest risk.

“Our results suggest that physician decision making about emergency cranial CT use for minor blunt head trauma is influenced by patient or family race/ethnicity, particularly at the lowest level of injury severity, for which few children should undergo cranial CT, to avoid irradiation,” the authors comment. “Notably, parental anxiety or request was cited as influencing clinical decision making more frequently among children of white non-Hispanic race/ethnicity, a phenomenon particularly common at the lowest level of injury severity.”

According to the study, disparities may potentially arise from the overuse of care among patients of nonminority race/ethnicities.

“Such overuse not only exposes individual patients to avoidable risks (in this case, long-term irradiation hazards) but also unnecessarily increases the costs of health care at a timAdidas Yeezy