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07-04-2013 | Radiology | Article

Pushy parents head for CT

Abstract

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medwireNews: Parents may unduly influence whether or not their child undergoes cranial computed tomography (CT) after sustaining minor blunt head trauma, researchers warn.

Four factors significantly predicted the likelihood of cranial CT in 2020 patients aged less than 15 years who attended a Japanese hospital between 2007 and 2012, 15% of whom underwent imaging, report Yasushi Ishida (St Luke's International Hospital, Tokyo, Japan) and co-authors.

Cranial CT was significantly more likely in patients with a high brain injury risk classification (relative risk [RR]=6.61 vs low risk), patients aged 7 years or older (RR=2.01 vs aged less than 2 years), and patients who were seen by an emergency department attending physician rather than a pediatrician (RR=1.54).

However, patients whose parents expressed a strong preference for head CT were also significantly more likely to undergo imaging than patients whose parents deferred to the physician, with a RR of 4.39.

Indeed, 38% of patients with a low injury risk whose parents favored head CT underwent imaging compared with only 2% of patients whose parents did not state a preference, the team reports in JAMA Pediatrics.

"The overuse of cranial CT in children, even for minor blunt head trauma, is a concern particularly in light of a recent report that showed CT scans in children delivering cumulative doses of about 50 mGy and 60 mGy might almost triple the risk of leukemia and brain cancer, respectively," Ishida et al write.

"Our results indicate that medically irrelevant factors such as parental preference may affect physician decision making and can result in unnecessary exposures to children."

The team therefore recommends further research to clarify the complex relationship between use of cranial CT and severity of injury risk, parental preference, and child's age.

"Although clinical benefits likely outweigh the small risks in most cases, radiation doses from CT should be kept as low as reasonably achievable, and alternative procedures should be considered, when appropriate," the researchers emphasize.

By Lynda Williams, Senior medwireNews Reporter

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