title: Privately insured medical patients are more likely to have a head CT.
abstract: Previous studies suggest overuse disparity of head computed tomography (CT) in white pediatric trauma patients with minor head injuries. Our study is meant to determine if race or insurance status impacts the probability of obtaining head CT in patients with a Glasgow Coma Scale (GCS) = 15. Using the 2008-2010 National Hospital Ambulatory Medical Care Survey for Emergency Departments (NHAMCS) database, the following variables were analyzed: race, emergency medical services (EMS) arrival, triage category, admission status, gender, age, and insurance status. Patients with injuries were excluded. All patients included had GCS = 15. In univariate analysis, head CT is more likely to be obtained for patients in the following categories: Medicare insured, private insurance, Medicaid insured, and self-pay, EMS arrival, triage category immediate, and age >75 years. In logistic regression, race (white vs. black) was no longer significant, but there was disparity based on insurance status with privately insured patients more likely to receive a head CT (OR = 1.683, 95 % CI = 1.255-2.259). After controlling for the above inclusion variables and focusing on patients less likely to need CT (non-traumatic with GCS = 15), privately insured patients were more likely to receive a head CT compared with uninsured. Race alone was not associated with an increased probability of receiving a head CT.
authors.affiliation: Central Michigan University College of Medicine, Mt. Pleasant, MI, USA. fortinem@gmail.com.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Fortin
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sheng
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Charlene Irvin
authors.initials: CI
authors.lastname: Babcock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States
keywords: CT; Clinical decision making; Disparity; Insurance; Radiation