title: Cranial computed tomography use among children with minor blunt head trauma: association with race/ethnicity.
abstract: OBJECTIVE
  To determine if patient race/ethnicity is independently associated with cranial computed tomography (CT) use among children with minor blunt head trauma.
  
  
  METHODS
  Secondary analysis of a prospective cohort study.
  
  
  METHODS
  Pediatric research network of 25 North American emergency departments.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA. joanne.natale @ucdmc.ucdavis.edu
authors.forename: JoAnne E
authors.initials: JE
authors.lastname: Natale
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Rogers
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
authors.forename: David H
authors.initials: DH
authors.lastname: Wisner
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Miskin
authors.forename: John D
authors.initials: JD
authors.lastname: Hoyle
authors.forename: Shireen M
authors.initials: SM
authors.lastname: Atabaki
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000208:ethnology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*