Severity of head computed tomography scan findings fail to explain racial differences in mortality following child abuse

Martin, Colin A.; Care, Marguerite; Rangel, Erika L.; Brown, Rebeccah L.; Garcia, Victor F.; Falcone, Richard A.

doi:10.1016/j.amjsurg.2009.05.001

« Previous Next »The American Journal of Surgery
Volume 199, Issue 2 , Pages 210-215, February 2010

Severity of head computed tomography scan findings fail to explain racial differences in mortality following child abuse

Colin A. Martin, M.D.
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
Marguerite Care, M.D.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
Erika L. Rangel, M.D., M.S.
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
Rebeccah L. Brown, M.D.
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
Victor F. Garcia, M.D.
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
Richard A. Falcone Jr., M.D., M.P.H.
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
- Corresponding author. Tel.: +1 513 636 4371; fax: +1 513 636 7657

Received 6 June 2008; received in revised form 15 October 2008 published online 06 November 2009.

Abstract

Introduction

Differences in head injury severity may not be fully appreciated in child abuse victims. The purpose of this study was to determine if differential findings on initial head computed tomography (CT) scan could explain observed differential outcome by race.

Methods

We identified 164 abuse patients from our trauma registry with an Injury Severity Score (ISS) ≥ 15. Their initial head CT scan was graded from 1 to 4 (normal to severe). Statistical analysis was performed to asses the correlation between race, head CT grade, Glascow Coma Scale (GCS) score, and mortality.

Results

Overall mortality was 17%: 11% for white children, 32% for African-American children (P < .05). In review of the head CT scans there was no difference by race in types of injuries or head CT grade. Using a multivariate regression model, African-American race remained an independent risk factor for mortality with an odd ratio of 4.3 (95% confidence interval [CI] 1.6–11.5).

Conclusion

African-American children had a significantly higher mortality rate despite similar findings on initial head CT scans. Factors other than injury severity may explain these disparate outcomes.

Keywords: Non-accidental trauma, Traumatic brain injury, Computed tomography, Outcomes disparities