Unnecessary CT Scans Performed More on White Children

White children who receive minor head injuries are more likely to undergo unnecessary cranial CT scans than black or Hispanic children, with “parental anxiety and request” as an important influence in the decision to test.

While racial disparities are normally presumed to reflect inadequate care of minority groups, they can also reflect "overuse of care among patients of nonminority races/ethnicities," said JoAnne E. Natale, MD, PhD, of the University of California Davis, and colleagues.

The researchers analyzed data from a prospective cohort study in the Pediatric Emergency Care Applied Research Network, which included 39,717 children with blunt head trauma examined between 2004 to 2006 in 25 North American centers.  

CT scans were performed on 13,793 children, who were separated into 3 groups based on their risk of clinically important brain injury. 

Among high-risk children, rates of scans remained similar with 84.1% of whites and 79.8% of black and Hispanic children undergoing the test.  In the low-risk and intermediate-risk groups, however, 17% of white children and 9.6% of black and Hispanic children, and 57.9% of whites and 50.8% of blacks and Hispanics received the test, respectively. 

The data, which also included factors influencing physician decision to scan, showed that 11.5% of low-risk white children who received scans were tested due to parental anxiety about the injury and parental request for scans, compared with 4.8% for the same reasons among scans of black and Hispanic children.  

"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," Natale and colleagues wrote.

-Michael Potts