A recent study found that white children are far more likely to receive CT scans than are African American or Hispanic children. Led by JoAnne Natale, medical director of the UC Davis Children’s Hospital Pediatric Intensive Care Unit and associate professor of pediatric critical care medicine at UC Davis School of Medicine, this study is an analysis of previous research, which found a prediction rule for CT scan use.
Natale analyzed a group of 40,000 children by looking primarily at the effects of race and ethnicity, though not the costs, of obtaining perhaps unnecessary CT scans.
The initial impetus for pursuing research in CT scanning of children younger than 18 years old is two-fold, according to Nathan Kuppermann, chair of the UC Davis department of emergency medicine and lead author of the previous research.
“[Because] CT use in this country is increasing at a very high rate and clinicians are using CT scans without good evidence, the purpose of this study was to generate evidence around CT use for children with head trauma, particularly because radiation is a real risk for children,” Kuppermann said.
Natale’s most recent study found that for children with more severe head trauma, there was no significant difference in the CT rate between the three race categories of children. However, in the low-risk group – that is, the children who probably are not in need of a CT scan – there was a greater difference with white children receiving CT scans more frequently.
Reasons for a disparity in CT scan usage among white, African American and Hispanic children are admittedly complicated, according to Natale and Kuppermann.
However, the study’s findings seem to indicate that an “important driver of inappropriate CT use” in low-risk children is parental requests made more by white parents than either of the other two races, Kuppermann said.
Emergency department physicians were more likely to report “parental requests” when asked to list the major influences on their decision to obtain a CT scan in a child with minor head trauma.
Although a very useful tool when injury is indicated, CT scans can be especially detrimental to children when injury is not indicated, given their high dosage of radiation and false positives.
The risk of CT scanning is “potentially higher for children, whose brains are still undergoing various forms of maturation, and are thus more vulnerable to the effects,” said Susan Rivera, professor of mind and psychology at the UC Davis Center for Mind and Brain.
Statistically speaking, Kuppermann estimates that for every 1,000 to 5,000 children that get a CT scan, depending on the age of the child, one might die from a lethal malignancy [or deadly cancer] and another couple might develop a malignancy they will survive from.
The emotional and economic costs of these decisions – to scan or not to scan – are an additional factor not explicitly addressed in Natale’s study, but certainly a topic for further research.
Peter Lindert, distinguished research professor of economics, argues there are three major reasons for a continued upward trend in the share of national income spent on health care costs – personal income, effect of aging and technology improvements in health care.
“For those demand and supply reasons, health care costs would go on rising even if the government were able to control prices,” Lindert said.
Natale’s study was keen on implementing the qualitative measurements suggested by Kuppermann by noting “the importance of strong, evidence-based guidelines to assure equal and optimal care.”
Embedding the evidence of their prediction rules in electronic health records, Kuppermann and his colleague at Columbia University won a $3.5 million grant from the American Recovery and Reinvestment Act.
Kuppermann and Natale hope that their research will decrease the rate of inappropriate CT scan use among emergency clinicians.
CHELSEA MEHRA can be reached at firstname.lastname@example.org.