Cranial computed tomography use among children with minor blunt head trauma: Association with race/ethnicity

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 Jr, Nathan Kuppermann

Research output: Contribution to journalArticle

44 Citations (Scopus)

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, 0.86; 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. 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.

Original languageEnglish (US)
Pages (from-to)732-737
Number of pages6
JournalArchives of Pediatrics and Adolescent Medicine
Volume166
Issue number8
DOIs
StatePublished - Aug 2012

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Craniocerebral Trauma
Tomography
Odds Ratio
Hispanic Americans
Hospital Emergency Service
Physicians
Decision Support Techniques
Decision Making
Cohort Studies
Anxiety
Outcome Assessment (Health Care)
Prospective Studies
Pediatrics
Delivery of Health Care
Traumatic Brain Injury
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Cranial computed tomography use among children with minor blunt head trauma : Association with race/ethnicity. / Natale, JoAnne E; Joseph, Jill G; Rogers, Alexander J.; Mahajan, Prashant; Cooper, Arthur; Wisner, David H; Miskin, Michelle L.; Hoyle, John D.; Atabaki, Shireen M.; Dayan, Peter S.; Holmes Jr, James F; Kuppermann, Nathan.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 166, No. 8, 08.2012, p. 732-737.

Research output: Contribution to journalArticle

Natale, JoAnne E ; Joseph, Jill G ; Rogers, Alexander J. ; Mahajan, Prashant ; Cooper, Arthur ; Wisner, David H ; Miskin, Michelle L. ; Hoyle, John D. ; Atabaki, Shireen M. ; Dayan, Peter S. ; Holmes Jr, James F ; Kuppermann, Nathan. / Cranial computed tomography use among children with minor blunt head trauma : Association with race/ethnicity. In: Archives of Pediatrics and Adolescent Medicine. 2012 ; Vol. 166, No. 8. pp. 732-737.
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