Racial disparities in health care—emergency department management of minor head injury

BACKGROUND/AIM: International research has demonstrated disparities in the Emergency Department care of patients of certain racial or ethnic backgrounds. The management of minor head injuries requires a careful clinical assessment to determine the requirement of a CT scan of the head. The aim of this study was to determine if there was any disparity, based on race, in the management of minor head injury. METHODS: This was a retrospective, structured, medical record review of patients presenting to The Townsville Hospital Emergency Department, between September 2004 and April 2007, with minor head injury. The main outcome measure was whether or not patients received a CT head scan when clinically indicated. The Canadian CT Head Rule was considered the standard for clinical indication for a CT head scan. Secondary outcome measures included triage category, waiting time, level of care provider, disposition and serum ethanol. RESULTS: A total of 270 patients (73 indigenous and 196 non-indigenous) were enrolled. There was no statistically significant difference in ordering CT head scans when clinically indicated between indigenous and non-indigenous patients. However, a trend indicating that indigenous patients were less likely to receive a CT head scan when clinically indicated (OR 0.35; 95% CI = 0.07 to 1.77) was noted. Indigenous patients had a mean waiting time of 44.6 min (SD 49.6) compared to non-indigenous with 31.1 min (SD 36.4; p = 0.02). CONCLUSION: This study concluded that there was no statistically significant disparity based upon race in the management of minor head injuries with regard to decision to perform a CT head scan. There is some evidence that indigenous patients waited longer to be seen. A multi-centre prospective study is necessary to confirm these findings.