HealthDay News — Willingness to subject children with a head injury to computed tomography (CT) scans decreases once parents are informed of the associated lifetime cancer risk, but most are still willing to proceed with the procedure, study results indicate.
“It has been suggested that parental desire for a rapid diagnosis is contributing to the increasing use of CT in children and is occurring without their full understanding of the potential risks,” Kathy Boutis, MD, from The Hospital for Sick Children in Toronto, and colleagues reported in Pediatrics.
Nearly half of parents surveyed whose child presented in the ED with a head injury reported some knowledge of the risk from ionizing radiation with CT scan (47%), the researchers found.
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More than 90% of those surveyed indicated they would like to be informed of potential malignancy risk prior to letting their child undergo the procedure, but only 6% refused the CT scan after disclosure.
CT scans expose patients to an estimated several hundred times more radiation than an x-ray, and children are particularly vulnerable to the associated health risks. Yet use of this procedure among children has increased fivefold since 1995.
“[W]e strongly recommend that [clinicians] be well informed of the benefits and potential risks of CT imaging,” the researchers wrote.
In their study, the researchers conducted a prospective cross-sectional survey of 742 parents whose children (median age 4 years) presented to a tertiary care pediatric emergency department with a head injury.
Almost all the children (97%) were ultimately diagnosed with a minor head injury or concussion, and 12% had a history of a prior CT scan.
Nearly two thirds (63%) of the parents had underestimated the danger associated with a CT scan: many of them assumed it was comparable to that of an x-ray, which may indicate an “inappropriately equal level of concern about radiation exposure and potential malignancy risks when a physician recommends radiographs or CT.”
The proportion of parents who were “very willing/willing” to proceed with head CT was 90.4% before disclosure of the risk. After parents were told that a head CT scan in a child, despite helping doctors make decisions about treatment, may carry an increased lifetime cancer risk around one in 10,000 vs. one in 1,000,000 for x-rays, the percentage of those willing to proceed decreased significantly to 69.6% (P<0.0001).
“Clinicians may therefore have a greater responsibility to initiate conversations with families about the risks/benefits of CT rather than doing so only when prompted by the patient,” the researchers wrote.
After disclosure 35% said they would have no second thoughts about proceeding with a CT scan if a doctor recommended the procedure, whereas 41% indicated they would seek further discussion on the matter.
Among the 42 parents (6%) who said they would refuse CT testing after disclosure of lifetime cancer risk, eight received a recommendation for CT imaging and all went through with it.
Study limitations included a lack of data on parents’ experience with cancer, and the large proportion of English-speaking, college-educated participants in the study population, which may make it difficult to generalize the findings to other sociodemographic groups.
