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Perceived Race and Ethnicity on CT Use in Children With Minor Head or Abdominal Trauma
Nisa S Atigapramoj1, Kevan McCarten-Gibbs1, Irma T Ugalde2
1UCSF Benioff Children's Hospital, Oakland, California.
Insights
Computed tomography (CT) use in children with blunt abdominal trauma (BAT) showed no racial or ethnic disparities. However, Hispanic children under 2 with head trauma may have lower CT imaging rates, suggesting potential disparities.
Area of Science:
- Pediatric trauma care
- Medical imaging disparities
- Health equity in pediatrics
Background:
- Computed tomography (CT) is crucial for diagnosing injuries in children following trauma.
- Understanding potential racial and ethnic disparities in CT utilization is essential for equitable pediatric care.
Purpose of the Study:
- To investigate the association between race/ethnicity and CT scan use in children experiencing minor blunt head trauma (BHT) or blunt abdominal trauma (BAT).
Main Methods:
- Prospective analysis of 17,339 children with BHT and 6,821 with BAT across 6 pediatric trauma centers.
- Injury severity assessed using Pediatric Emergency Care Applied Research Network (PECARN) rules.
- Multivariable logistic regression controlled for site, age, sex, Social Deprivation Index, and injury severity.
Main Results:
- For BHT, no significant differences in CT use were found for Hispanic, Asian, or Black children aged 2 years and older compared to non-Hispanic white children.
- For BHT in children younger than 2 years, Hispanic ethnicity was associated with less CT use (aOR, 0.75; 95% CI, 0.59-0.96).
- For BAT, CT use was similar across all racial and ethnic groups compared to non-Hispanic white children.
Conclusions:
- CT utilization for pediatric blunt abdominal trauma is equitable across racial and ethnic groups.
- Potential disparities in head CT imaging may exist for Hispanic children under 2 years old, warranting further investigation into imaging practices.
Objective:
To determine whether race or ethnicity is associated with computed tomography (CT) use in children after minor blunt head trauma (BHT) or blunt abdominal trauma (BAT).
Methods:
This was a prospective secondary analysis of children (<18 years) with BHT and/or BAT at 6 pediatric trauma centers. Injury severity was assessed using the Pediatric Emergency Care Applied Research Network prediction rules. We performed multivariable logistic regression, controlling for site, age, sex, Social Deprivation Index, and injury severity.
Results:
In total, 17 339 patients with BHT were enrolled. For patients aged 2 years or older, compared with the reference group (∼85% non-Hispanic white patients), there was no difference in CT use for Hispanic ethnicity (adjusted odds ratio [aOR], 0.96; 95% CI, 0.86-1.08), non-Hispanic Asian (aOR, 1.06; 95% CI, 0.82, 1.37), or Black race (aOR, 1.03; 95% CI, 0.89-1.19). For patients aged younger than 2 years, there was no difference in CT use for Asian (aOR, 1.07; 95% CI, 0.70-1.63) or Black race (aOR, 1.20; 95% CI, 0.89-1.62) but less CT use for Hispanic patients (aOR, 0.75; 95% CI, 0.59-0.96). In all, 6821 patients with BAT were enrolled. Compared with the reference group (∼95% non-Hispanic white), there were no significant differences in CT use for patients who were Asian (aOR, 0.98; 95% CI, 0.68-1.40), Black (aOR, 0.89; 95% CI, 0.73-1.40), or Hispanic (aOR, 0.96; 95% CI, 0.81-1.13).
Conclusions:
CT use in children with BAT was similar across racial and ethnic groups. However, head CT rates in Hispanic children aged younger than 2 years may reflect disparities in imaging practices.
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