White children far more likely to receive CT scans than Hispanic, African-American children

The study findings do not indicate that CT scans are underused in treating African-American and Hispanic children, the researchers said. Rather, they suggest that white children may receive too many CT scans -- and for that reason may be exposed to unnecessary radiation.

The study results were presented October 16 at the American College of Emergency Physicians (ACEP) Scientific Assembly by JoAnne E. Natale, associate professor of pediatric critical care medicine at the UC Davis School of Medicine and the study's lead author.

"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," Natale said.

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.

For the current study, 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 in which a CT scan may be indicated.

Natale, who also is the medical director of the UC Davis Children's Hospital Pediatric Intensive Care Unit, said that the study utilized data compiled for a seminal 2009 study by UC Davis authors, which found that CT scans are not necessary for children at very low risk of clinically significant traumatic brain injury.

The 2009 study was lead 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, under the auspices of the Pediatric Emergency Care Applied Research Network (PECARN) between 2004 and 2006.

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 children 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 said. She said that the 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 said. "Our study highlights the importance of strong, evidence-based guidelines to ensure equal and optimal care for all children."

The study 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.

Other study authors include David Wisner, Nathan Kuppermann, and James F. Holmes, all of UC Davis. Authors from other institutions include Alexander J. Rogers, University of Michigan, Ann Arbor; Jill G. Joseph, George Washington University, Washington, D.C.; Prashant Mahajan, Children's Hospital of Michigan, Detroit; Michelle L. Miskin, PECARN Central Data Management and Coordinating Center, Salt Lake City; John D. Hoyle, Helen DeVos Children's Hospital/Michigan State University, Grand Rapids; Shireen M. Atabaki, Children's National Medical Center, Washington, D.C.; and Peter S. Dayan, College of Physicians & Surgeons, Columbia University, New York, NY.