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 language | English (US) |
|---|---|
| Pages (from-to) | 732-737 |
| Number of pages | 6 |
| Journal | Archives of Pediatrics and Adolescent Medicine |
| Volume | 166 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2012 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
Cite this
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 journal › Article
}
TY - JOUR
T1 - Cranial computed tomography use among children with minor blunt head trauma
T2 - Association with race/ethnicity
AU - Natale, JoAnne E
AU - Joseph, Jill G
AU - Rogers, Alexander J.
AU - Mahajan, Prashant
AU - Cooper, Arthur
AU - Wisner, David H
AU - Miskin, Michelle L.
AU - Hoyle, John D.
AU - Atabaki, Shireen M.
AU - Dayan, Peter S.
AU - Holmes Jr, James F
AU - Kuppermann, Nathan
PY - 2012/8
Y1 - 2012/8
N2 - 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.
AB - 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.
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U2 - 10.1001/archpediatrics.2012.307
DO - 10.1001/archpediatrics.2012.307
M3 - Article
C2 - 22869404
AN - SCOPUS:84865606877
VL - 166
SP - 732
EP - 737
JO - JAMA Pediatrics
JF - JAMA Pediatrics
SN - 2168-6203
IS - 8
ER -