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White kids get more scans for low-risk head trauma

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NEW YORK (Reuters Health) - When kids have minor, but high-risk, head injuries, race doesn't seem to be a factor determining who gets sent for CT scanning, a new study finds. But for lower-risk injuries, white children are getting more - and likely too many - of the scans.

Researchers found that of 39,717 children across the U.S. with minor head trauma, about 42 percent of the white kids had computed tomography - a high-powered X-ray - of the head while 28 percent of black and Hispanic children got the scans.

The difference does not mean that black and Hispanic children were getting worse care, the researchers say. Rather, the white children could be getting unnecessary and potentially risky care - in part, because their parents demand it.

"It's often that the minority groups get worse care, but what we found is that the whites are more likely to get CT scans that are not indicated and could be risky because of the radiation exposure," said Dr. JoAnne Natale, the study's lead author and a professor of pediatrics at the University of California, Davis.

In this case, Natale said, "it's actually opposite because the blacks and Hispanics are getting better care... and the whites are getting too much (care)."

Traumatic brain injuries - usually caused by blows to the head - account for more than 7,000 deaths, 60,000 hospital admissions and 600,000 emergency room visits in the United States every year, according to Natale and her colleagues, who published their findings in the Archives of Pediatrics & Adolescent Medicine on Monday.

Past research, they note, has found that black kids typically fare worse than whites after such an injury.

CT SCANS BY RACE

To see whether there were racial differences in the treatment kids received, Natale's group looked at who got a head CT - a fairly typical scan in cases of head injury - in emergency rooms.

They analyzed data from a large existing study looking at 25 emergency rooms across the U.S., where doctors were asked to complete questionnaires about children treated for head trauma between June 2004 and September 2006.

The study covered more than 42,000 children under 18 seen within 24 hours of a minor head injury.

Minor means the child had something more serious than just a bump on the head, but it excludes very severe head traumas.

Still, there can be unseen internal damage and within the minor-injury category, there are high, intermediate and low levels of risk, as determined by the specific circumstances of the injury and the child's symptoms.

Children in the highest-risk groups typically get CT scans because their symptoms - such as unconsciousness - are so serious. In that category, Natale and her colleagues did not see any differences in treatment based on race or ethnicity. Around 80 percent of all kids got scans.

For those in the intermediate- and low-risk groups, however, white children were more likely to get a CT scan.

Natale told Reuters Health that those cases are where doctors have more discretion in choosing whether or not to scan a child.

For kids at an intermediate risk of a brain injury, about 58 percent of the white kids got scanned, compared to about 51 percent of black and Hispanic children.

The difference in the lowest-risk group was more pronounced, with 17 percent of white kids getting scanned compared to about 10 percent of the black and Hispanic kids.

As for why white kids are getting scanned more, Natale said the team can't say from their data. Across the board, however, doctors said parental anxiety and requests played more of a role in the treatment of white children than it did for blacks and Hispanics.

There may be other factors at work too, they add, since the results don't take into account insurance status or specific reasons doctors did not order a CT scan for some children.

LEVELING THE PLAYING FIELD

"All this disparities work has to do with is leveling the playing field for all patients. Race and ethnicity should play no role in health care... And getting too much care is as inequitable as not providing to enough care," Natale told Reuters Health.

In the case of white children getting unnecessary CT scans, it may expose them to increased risks from the radiation later in life.

A recent study from an international group of researchers found that two or three childhood CT scans may triple the risk of developing brain cancer later in life (see Reuters story of June 6, 2012. http://reut.rs/Ms8cWl).

In an editorial published with the new study, Dr. M. Denise Dowd, of Children's Mercy Hospital in Kansas City, Missouri, said overconsumption of healthcare in one group can push costs up for everyone.

In the U.S., a CT scan can cost between a few hundred dollars and one thousand.

Natale told Reuters Health that data on pediatric emergency care has been incorporated into a set of rules to guide a doctor's treatment decisions. And such rules should eliminate race or ethnicity from playing a role in the decision-making process.

"As doctors, these kinds of decision rules help us tremendously to take care of patients," she said. Regarding the guidance on CT scans in case of head injury, "It's a well-developed rule and it's well-evaluated," Natale noted, adding that she could not say how many doctors actually use the rule and that further research is needed to say whether or not it actually eliminates the disparity.

SOURCE: http://bit.ly/Ms92Cy Archives of Pediatrics & Adolescent Medicine, online August 6, 2012.

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