Overuse of CT scans in white kids with milder head injuries

Balancing risks and benefits

Interesting study out of the University of Michigan (my pediatric residency alma mater) this week: White kids being evaluated for head injuries in pediatric trauma center emergency rooms were significantly more likely to undergo a head CT scan than the African-American or Hispanic children seen in the same ER. Big study–over 40,000 visits.

Ah, but there’s a twist to this tale. This isn’t the usual sad story of underprivileged/under-insured kids getting substandard/lousy care: CT usage in cases of truly serious head injury was the same for all three groups. Which means that the increase in CT scans in white kids was seen only in cases of milder trauma…injuries that might not really have needed the scans in the first place.

So, what gives? Why would white children end up with more possibly unnecessary scans than other kids? The authors aren’t sure yet, but–I’m speculating here–defensive medicine and having insurance that’ll pay for the scans may well be part of the answer.

My main concern? That’s a lot of radiation for a young child’s brain to absorb. For kids with serious head injuries, it’s definitely worth the risk; for milder injuries, not so much.

If you’re in a science-wonky mood, here’s an article from the New England Journal of Medicine that explains CT scans and their radiation risks (see figure 3 in particular). If you’re all wonked out today, here’s the skinny: The younger the child, the greater the risk of developing later cancer from radiation exposure. Though the numbers have been questioned, it appears that as many as 6 to 8 infants out of every 1,000 who receive a single head CT may develop brain cancer down the road as a result. The risk decreases to less than 1 in 1,000 by the mid-teenage years. (Source: see figure 3 of the NEJM article).

Parents should feel comfortable questioning the need for a CT scan of any kind, even in an emergency room, and to have the risks and benefits of the scan laid out for them. Will the CT provide information that can’t be obtained by other means?

But please remember, there’s a time and place for all medical technology. Sometimes you really do need a CT scan.

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