Purpose or Case Report: Head CT is not recommended as a first test to evaluate non-traumatic headaches in children unless the headache is acutely severe. While CT can provide important diagnostic information, they expose children to radiation and increase healthcare costs. The purpose of this investigation is to evaluate the association between insurance type and the likelihood of receiving a head CT scan for headache in a single pediatric hospital system.
Methods & Materials: All children presenting with a chief complaint of headache at either of two pediatric emergency departments affiliated with a large pediatric healthcare system over 1 month were retrospectively reviewed. Patients with a history of trauma, charity care patients, and self-pay patients were excluded. We developed a multivariate logistic regression model. The outcome variable was whether or not the patient received a head CT scan. The predictor variables were insurance type (commercial or government) and hospital location (urban main or suburban satellite).
Results: 333 patients presented with headache during the period studied. 38 patients total (11.4%) received a head CT scan, comprising 23 of 100 patients (23%) with private insurance and 15 of 233 patients (6%) with government insurance. On multivariate logistic regression, after controlling for the location of the hospital, having private insurance was independently associated with a higher probability of receiving a head CT scan. The odds ratio of CT imaging in patients with commercial compared to government insurance was 3.72.
Conclusions: Commercially insured children who presented with headache were 3.72 times as likely to receive head CT imaging compared to those with government insurance. Multiple patient- and provider-driven factors may contribute to this difference. Parents of children with commercial insurance may have higher socioeconomic status, education, and familiarity with imaging. These factors may influence them to request more imaging. As to provider effects, physicians may order more imaging for privately insured patients because of possible implicit bias, insurance reimbursement concerns, and/or litigation risk. The difference in the likelihood of CT raises concerns about health care disparities between children with government insurance and those with private insurance as well as greater risk of radiation exposure among those with private insurance.