TY  - JOUR
T1  - Cranial computed tomography use among children with minor blunt head trauma: Association with race/ethnicity
AU  - Natale JE, Joseph JG, Rogers AJ, et al
Y1  - 2012/08/01
N1  - 10.1001/archpediatrics.2012.307
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 732
EP  - 737
VL  - 166
IS  - 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.
SN  - 1072-4710
M3  - doi: 10.1001/archpediatrics.2012.307
UR  - http://dx.doi.org/10.1001/archpediatrics.2012.307
ER  -