White youth more likely to get CT scans

UC DAVIS (US) — White children are far more likely to receive CT scans in an emergency room after minor head trauma than African-American or Hispanic children, a new study shows.

The findings don’t indicate that African Americans or Hispanics don’t receive enough scans, but rather that white children may be receiving too many—and are therefore being exposed to unnecessary radiation.

Cranial computed tomography imaging commonly is used to determine the severity of injury in children and adults in emergency departments. Cranial CT scans use X-rays to image the cranium, brain, eye sockets, and sinuses.


However, in children with mild head trauma, earlier studies have found that fewer than 10 percent of CT scans identify a traumatic brain injury. CT scans use a significant amount of radiation and thus increase the risk of potential subsequent malignancies.

“The higher rates of cranial CT scan use in children at low risk for clinically significant brain injury may represent overuse in white children, leading to increased radiation exposure and health-care costs,” says JoAnne E. Natale, associate professor of pediatric critical care medicine at the University of California, Davis.

Researchers examined data from children whose race and/or ethnicity was Hispanic, non-Hispanic African American, or non-Hispanic white. Although all of the children had minor head trauma, some could be categorized as being at greater risk of a clinically significant injury for which a CT scan may be indicated.

Natale and colleagues presented their research at the American College of Emergency Physicians (ACEP) Scientific Assembly Oct. 16.

The new research was based on a 2009 study by Nathan Kuppermann, co-author of the current study and chair of the UC Davis department of emergency medicine. That study enrolled more than 40,000 children nationwide with minor head trauma who presented at 25 U.S. emergency departments between 2004 and 2006, under the auspices of the Pediatric Emergency Care Applied Research Network (PECARN).

The current study found that a child’s race and/or ethnicity did not influence the likelihood of receiving a CT scan among children with minor head trauma at the greatest risk of having a clinically important brain injury.

However, among lower-risk children, non-Hispanic white children were more likely to receive a CT scan than were non-Hispanic African-American and children of Hispanic descent.

In addition to the increased risks posed by radiation exposure, overuse of CT scans in non-Hispanic white children also has impacts on overall health-care costs, Natale says.  Overuse of CT scans is part of a well-documented pattern of providing more care than is necessary to individuals of certain racial and/or ethnic groups, which in turn places additional burdens on health-care costs.

“Clearly, further studies should focus on explaining racial differences in the use of emergent neuroimaging,” Natale says. “Our study highlights the importance of strong, evidence-based guidelines to ensure equal and optimal care for all children.”

Researchers from Michigan State University, the University of Michigan, George Washington University, and Columbia University contributed to the study that was funded by a grant from the Emergency Medical Services for Children Program of the Health Resources and Services Administration’s Maternal and Child Health Bureau.

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