• JoAnne E Natale, Jill G Joseph, Alexander J Rogers, Prashant Mahajan, Arthur Cooper, David H Wisner, Michelle L Miskin, John D Hoyle, Shireen M Atabaki, Peter S Dayan, James F Holmes, Nathan Kuppermann, and PECARN (Pediatric Emergency Care Applied Research Network).
• Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA. joanne.natale @ucdmc.ucdavis.edu
• Arch Pediatr Adolesc Med. 2012 Aug 1;166(8):732-7.

ObjectiveTo determine if patient race/ethnicity is independently associated with cranial computed tomography (CT) use among children with minor blunt head trauma.DesignSecondary analysis of a prospective cohort study.SettingPediatric research network of 25 North American emergency departments.PatientsIn 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 MeasureCranial CT use in the emergency department, stratified by race/ethnicity.ResultsIn 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.ConclusionsDisparities 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.

20 keywords...

hide…