White Children More Likely to Receive Head CTs

White children at low risk for brain injury are more likely to receive CT scans in the emergency room than Hispanic or African-American children - often because of parental anxiety or request, researchers found.

“We found that although the use of CT scans was appropriate across all racial groups for those children at higher risk of a brain injury following apparently minor head trauma, for children with only minimal risk, CT was overused in white children,” said JoAnne E. Natale, associate professor of pediatric critical care at UC Davis and the study’s lead author. “In many instances, doctors appear to be responding to parental anxiety rather than medical evidence.”

If the decision to perform the scan was based on clinically important brain injury, white, African-American and Hispanic children underwent the scans in equal numbers, according to the study published in the August issue of Archives of Pediatrics & Adolescent Medicine and presented last October at the American College of Emergency Physicians Scientific Assembly. However, if the children were at lower risk and the physicians’ requests for scanning were due to parental anxiety or request, more white children were scanned than those in either of the other two groups.

Researchers from UC Davis School of Medicine analyzed data from more than 42,000 cases of children who were identified as either Hispanic, non-Hispanic African American, or non-Hispanic white, who presented at one of 25 emergency departments across the U.S. with minor head trauma between 2004 and 2006. The researchers looked for children who could be categorized as being at greater risk of a clinically significant injury, resulting in recommendations for CT scans. The records indicated the most important criteria (medical and non-medical, such as parental request) that influenced the decision.

Emergency room physicians reported that they were prompted to order CT scans in 12 percent of the cases involving white children who had the lowest risk of important brain injury. The rate was only 5 percent for the other two groups.

Nathan Kuppermann, chair of the UC Davis Department of Emergency Medicine and senior author of the study, called for caution in ordering the scans. “Minor head trauma is extremely common in the pediatric population,” he said. “It is important to use evidence to avoid the inappropriate use of CT and potentially induce harm later in life.”

The risk of malignancy from CT radiation has been reported in published studies, including one that appeared recently in Lancet. This study found that although the absolute risk of developing cancer remains small, children who underwent two or three CT scans before the age of 15 had tripled their risk of developing brain cancer. If they had undergone five to 10 scans, they tripled their risk of developing leukemia.