The odds of undergoing head CT for minor blunt head trauma were higher for white children than for Hispanic or non-Hispanic blacks, but minority kids might actually be better off due to the disparity, according to a new data analysis in the August Archives of Pediatrics and Adolescent Medicine.
That's because some scans in nonminority children might have been associated with parental anxiety or requests for scans despite a lack of evidence to recommend CT in the clinical context, according to the researchers from the University of California, Davis.
Dr. JoAnne Natale, PhD, and colleagues performed a secondary analysis of a study conducted between June 2004 and September 2006 in a pediatric research network of 25 emergency departments. A total of 39,717 children whose ethnicity was documented were analyzed for the study, which included 41.8% white non-Hispanic, 26.9% black non-Hispanic, and 32% Hispanic children. Of this group, 13,973 underwent cranial CT for minor blunt head trauma (Arch Pediatr Adolesc Med, August 2012, Vol. 166:8, pp. 732-737).
Racial or ethnic disparities were seen among patients with a low or intermediate risk of clinically important traumatic brain injury (TBI), with children of white non-Hispanic race/ethnicity more likely to undergo cranial CT, according to the researchers. 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) or lowest risk (odds ratio, 0.72).
Physician decisions about emergency cranial CT use for minor blunt head trauma may be influenced by patient or family race/ethnicity, particularly at the low end of injury severity, for which CT should be used only rarely, the authors concluded. In addition to parents' expressed anxiety and requests among nonminority patients, the general overuse of care among nonminority patients may have also been a factor.
Traumatic brain injury is a leading cause of pediatric illness and death in the U.S., Natale and colleagues noted, and is responsible for about 600,000 emergency department visits each year.
