August 7, 2012
Racial Disparities In Cranial CT Among Children Examined
The odds of undergoing cranial computed tomography (CT) among children with minor blunt head trauma who were at higher risk for clinically important traumatic brain injury did not appear to differ by race/ethnicity in a secondary analysis of a study of injured children, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication. However, there may have been differences for children at intermediate or lowest risk.
Traumatic brain injury (TBI) is a leading cause of pediatric illness and death in the U.S., responsible for about 7,400 deaths, 60,000 hospital admissions and more than 600,000 emergency department visits each year. Cranial CT is the standard of care for emergency diagnosis of TBI, but irradiation is associated with increased long-term risk for malignancies, according to the study background.
JoAnne E. Natale, M.D., Ph.D., of the University of California, Davis, Sacramento, 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. Of 42,412 children with minor blunt head trauma enrolled in the main study, 39,717 had their race/ethnicity documented as white non-Hispanic, black non-Hispanic or Hispanic. A total of 13,793 children underwent cranial CT with rates of 41.8 percent, 26.9 percent and 32 percent respectively for white non-Hispanic, black non-Hispanic and Hispanic children.
Researchers suggest racial/ethnic disparities were observed among children with the lowest risk or an intermediate risk of clinically important traumatic brain injury (ciTBI), with children of white non-Hispanic race/ethnicity more likely to undergo cranial CT.
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), the study's results indicate.
"Our results suggest that physician decision making about emergency cranial CT use for minor blunt head trauma is influenced by patient or family race/ethnicity, particularly at the lowest level of injury severity, for which few children should undergo cranial CT, to avoid irradiation," the authors comment. "Notably, parental anxiety or request was cited as influencing clinical decision making more frequently among children of white non-Hispanic race/ethnicity, a phenomenon particularly common at the lowest level of injury severity."
The authors note the disparities may potentially arise from the overuse of care among patients of nonminority race/ethnicities.
"Such overuse not only exposes individual patients to avoidable risks (in this case, long-term irradiation hazards) but also unnecessarily increases the costs of health care at a time when financial restraint is increasingly emphasized," they conclude.
(Arch Pediatr Adolesc Med. 2012;166:732-737. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: This work was supported by a grant from the Health Resources and Services Administration's Maternal and Child Health Bureau, Emergency Medical Services for Children and Division of Research, Education and Training. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Disparities in Health Care
In an editorial, M. Denise Dowd, M.D., M.P.H., of Children's Mercy Hospital, Kansas City, Mo., writes: "Overuse is a well-recognized but largely undealt with problem in U.S. health care. It is perhaps nowhere more clearly demonstrated than in the use of diagnostic imaging studies."
"Discerning and managing the often delicate balance between efficiency, safety, timeliness, equity and patient centeredness is difficult and will never be handled well by a practice guideline or set of rules, including laws," Dowd continues.
"Reducing waste and minimizing harm while being patient centered and equitable in our care calls on the best of our science and as well the best of the art of medicine. For that to happen, we will need to develop better insight into why we do what we do at the bedside," Dowd concludes.
(Arch Pediatr Adolesc Med. 2012;166:770-772. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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