Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma: Association With Race/Ethnicity | Traumatic Brain Injury | JAMA Pediatrics | JAMA Network
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Article
Aug 2012

Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma: Association With Race/Ethnicity

Author Affiliations

Author Affiliations: Departments of Pediatrics (Drs Natale and Kuppermann), Surgery (Dr Wisner), and Emergency Medicine (Drs Holmes and Kuppermann) and Betty Irene Moore School of Nursing (Dr Joseph), University of California, Davis, Sacramento; Departments of Emergency Medicine and Pediatrics, University of Michigan Medical Center, University of Michigan School of Medicine, Ann Arbor (Dr Rogers), Departments of Pediatrics and Emergency Medicine, Children's Hospital of Michigan, Detroit (Dr Mahajan), and Department of Emergency Medicine, Helen DeVos Children's Hospital, Michigan State University, East Lansing (Dr Hoyle); Department of Pediatric Surgery, College of Physicians and Surgeons at Harlem Hospital Center (Dr Cooper), and Department of Pediatric Emergency Medicine, College of Physicians and Surgeons (Dr Dayan), Columbia University, New York, New York; Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, Utah (Ms Miskin); and Department of Emergency Medicine, Children's National Medical Center, Washington, DC (Dr Atabaki).

Arch Pediatr Adolesc Med. 2012;166(8):732-737. doi:10.1001/archpediatrics.2012.307
Abstract

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, 0.84; 95% CI, 0.76-0.94) or lowest risk (odds ratio, 0.73; 95% CI, 0.66-0.81) 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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