A Study of Skeletal Survey Disparity in Pediatric Head Injury in the Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Radiology
• Health Disparities Research

Background:

• Skeletal surveys (SS) are used to detect fractures in pediatric head injury patients.
• Concerns exist regarding potential disparities in SS utilization based on patient demographics.
• The prevalence of occult fractures in this population requires further investigation.

Purpose of the Study:

• To evaluate disparities in skeletal survey (SS) use among pediatric patients presenting to the emergency department (ED) with head injuries.
• To determine associations between SS completion and various demographic factors including race, ethnicity, language, insurance, and socioeconomic status.
• To assess the prevalence of occult fractures in children under 24 months with head injuries.

Main Methods:

• Multi-site retrospective cohort study of children under 24 months with suspected head injury and CT evidence of injury.
• Analysis of adjusted associations between SS completion and demographic variables.
• Sub-analyses conducted for children under 6 months and those with complex injuries.
• Evaluation of occult fracture prevalence.

Main Results:

• A total of 270 children met the study criteria, with 88 undergoing skeletal surveys.
• No statistically significant associations were found between SS completion and race, ethnicity, language for care, private insurance, or median census tract income.
• Occult fractures were identified in 2.3% of patients who had SS, with both cases having risk factors for non-accidental trauma (NAT).

Conclusions:

• No statistical disparities in skeletal survey utilization were identified based on patient demographics.
• Occult fractures are uncommon in pediatric head injury patients.
• Skeletal survey use may be safely reduced in lower-risk pediatric head injury patients, potentially optimizing resource allocation.