Cranial computed tomography use among children with minor blunt head trauma: association with race/ethnicity
JoAnne E Natale1, Jill G Joseph, Alexander J Rogers
1Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA. joanne.natale @ucdmc.ucdavis.edu
Insights
Patient race/ethnicity impacts cranial computed tomography (CT) use in children with head trauma. Black and Hispanic children had lower CT rates, suggesting potential disparities in care.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Medical Imaging
Background:
- Cranial computed tomography (CT) is frequently used for evaluating minor blunt head trauma in children.
- Understanding factors influencing CT utilization is crucial for optimizing care and minimizing radiation exposure.
Purpose of the Study:
- To investigate whether patient race/ethnicity is an independent predictor of cranial CT use in pediatric patients with minor blunt head trauma.
- To identify potential racial/ethnic disparities in diagnostic imaging decisions.
Main Methods:
- Secondary analysis of a prospective cohort study involving 42,412 children across 25 North American emergency departments.
- Children were stratified by risk for clinically important traumatic brain injury using a validated prediction rule.
- Cranial CT utilization was compared across white non-Hispanic, black non-Hispanic, and Hispanic children.
Main Results:
- Overall, 34.7% of children underwent cranial CT.
- While high-risk children showed no difference in CT rates by race/ethnicity, black non-Hispanic and Hispanic children had lower odds of CT in intermediate and lowest risk groups.
- Parental anxiety and requests were frequently cited for ordering CT in white non-Hispanic children.
Conclusions:
- Racial and ethnic disparities may exist in cranial CT utilization for pediatric head trauma, potentially driven by non-medical factors.
- Further research is needed to understand how patient race/ethnicity influences physician decision-making and leads to differential healthcare exposure.
- Addressing these disparities can help reduce unnecessary radiation exposure in children.
Objective:
To determine if patient race/ethnicity is independently associated with cranial computed tomography (CT) use among children with minor blunt head trauma.
Design:
Secondary analysis of a prospective cohort study.
Setting:
Pediatric research network of 25 North American emergency departments.
Patients:
In total, 42 412 children younger than 18 years were seen within 24 hours of minor blunt head trauma. Of these, 39 717 were of documented white non-Hispanic, black non-Hispanic, or Hispanic race/ethnicity. Using a previously validated clinical prediction rule, we classified each child's risk for clinically important traumatic brain injury to describe injury severity. Because no meaningful differences in cranial CT rates were observed between children of black non-Hispanic race/ethnicity vs Hispanic race/ethnicity, we combined these 2 groups.
Main Outcome Measure:
Cranial CT use in the emergency department, stratified by race/ethnicity.
Results:
In total, 13 793 children (34.7%) underwent cranial CT. The odds of undergoing cranial CT among children with minor blunt head trauma who were at higher risk for clinically important traumatic brain injury did not differ by race/ethnicity. In adjusted analyses, children of black non-Hispanic or Hispanic race/ethnicity had lower odds of undergoing cranial CT among those who were at intermediate risk (odds ratio, 0.86; 95% CI, 0.78-0.96) or lowest risk (odds ratio, 0.72; 95% CI, 0.65-0.80) for clinically important traumatic brain injury. Regardless of risk for clinically important traumatic brain injury, parental anxiety and request was commonly cited by physicians as an important influence for ordering cranial CT in children of white non-Hispanic race/ethnicity.
Conclusions:
Disparities may arise from the overuse of cranial CT among patients of nonminority races/ethnicities. Further studies should focus on explaining how medically irrelevant factors, such as patient race/ethnicity, can affect physician decision making, resulting in exposure of children to unnecessary health care risks.
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