African-American children with traumatic brain injuries resulting from abuse or nonaccidental trauma are three times more likely to die in hospital emergency departments than Caucasian children, a new study indicates.
This sobering statistic was found at Cincinnati Children's Hospital Medical Center, which operates a level I pediatric trauma center for residents of southern Ohio and northern Kentucky.
Prior formal analyses conducted by hospital researchers adjusting for injury severity and insurance status haven't explained this racial disparity. Pediatric radiologists hypothesized that they might gain insight into the discrepancy through a clinical evaluation of head CT exams of children who had sustained severe head injuries from abuse.
They conducted a retrospective study of children admitted to Cincinnati Children's Hospital over a 10-year period. Their findings, published in a recent issue of the American Journal of Surgery (2010, Vol. 199:2, pp. 210-215), generate more questions and no answers.
Trauma registry records were used to identify 164 victims of child abuse younger than 16, who had severe head injuries and were admitted to the hospital's level I pediatric trauma center between 1994 and 2004. The children ranged in age from 11 days to 16 years (median, 1.6 years), and the majority were boys (65%). The victims included 107 Caucasian children (65%), 41 African-American children (25%), and 16 children (10%) of other ethnicities, who were not included in the detailed analysis due to their low numbers.
Thirty-two percent of the African-American children died, compared with 10% of Caucasian children and 19% for the mixed-race group.
The percentage of children with multiple findings on head CT exams was comparable for African-American (51%) and Caucasian (52%) children, yet 50% of these African-American children died, compared with 17% of the Caucasian children. Not surprisingly, 26% of all children with multiple identified head injuries died, compared to 9% with a single identified head injury.
A pediatric neuroradiologist blinded to patients' race and outcome reviewed all of the head CTs to assess and rank the severity of injuries. Fractures, subdural hematomas, edemas, diffuse injuries, herniations, and midline shifts were identified for each patient. No significant differences were identified between patients of each race, yet within each grade of head CT severity (I = normal to IV = severe), African-American children had a higher mortality rate.
Dr. Richard Falcone Jr., director of trauma services, and colleagues subsequently evaluated additional diagnoses of injuries, because certain injuries and combinations are associated with worse outcomes. None of their clinical analyses could identify any independent predictors of mortality.
Due to a lack of data, the authors could not analyze a child's pre-existing comorbidities, overall prehospital health status, parent or guardian access to healthcare services for the child, and time delay in taking the child for treatment after the injury was sustained. They strongly recommended that this information be documented in detail in patient electronic medical records and be evaluated in future studies relating to racial mortality disparities.
By Cynthia E. Keen
AuntMinnie.com staff writer
April 9, 2010
Related Reading
PET recommended for skeletal trauma to identify child abuse, March 24, 2010
Occult abdominal trauma common in children with suspected physical abuse, November 25, 2009
MRI with STIR fails to change diagnosis in child abuse cases, May 12, 2009
Several clinical markers help detect abusive head trauma in young children, October 28, 2008
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