English versus Non-English Language Preference and Computed Tomography Use in Pediatric Minor Head Trauma

Introduction: Whether the use of computed tomography (CT) in pediatric minor head trauma varies by documented language preference (English vs non-English), independent of race, is not well understood. Our objective was to identify factors associated with head CT use among children with minor head trauma in an institutional Pediatric Emergency Care Applied Research Network (PECARN)-based pathway. Methods: This single-center retrospective cohort study included patients 2 to 14 years of age presenting with minor head trauma, January 2019 to June 2022, who were classified as low, intermediate, or high risk using PECARN criteria. Our primary outcome measure was a three-level clinical pathway: no CT and no traumatic brain injury (TBI); clinical TBI without CT; or CT performed. Secondary outcomes were CT positivity and short-term clinical outcomes. Multinomial logistic regression assessed associations between pathway and language preference, age, headache, weighted observed symptom score (OSS), and race (White vs non-White). Results: Among 1,167 patients, 319 (27.3%) underwent CT, 132 (11.3%) had clinical TBI diagnosis without CT, and 716 (61.4%) had neither; 430 (36.8%) were classified intermediate risk—the subgroup in which the imaging decision is most discretionary. Non-English language preference was associated with lower adjusted odds of CT in the intermediate-risk subgroup (adjusted odds ratio [aOR], 0.48; 95% CI, 0.24-0.92; P = .03) but not in the full cohort (aOR, 0.78; 95% CI, 0.50-1.22; P = .27). Within the intermediate-risk subgroup, OSS was strongly associated with CT use (aOR, 3.65; 95% CI, 2.67-5.00; P < .001) and headache with clinical TBI without CT (aOR, 4.94; 95% CI, 1.64-14.90; P = .005), whereas race was not independently associated with CT use (aOR, 1.36; 95% CI, 0.82-2.25; P = .48). Language preference was not associated with CT positivity among scanned patients (aOR, 1.10; 95% CI, 0.44-2.72; P = .84), and short-term outcomes did not differ by language (all P > .35). Conclusion: Documented non-English language preference was independently associated with lower use of head CT in PECARN intermediate-risk children; race was not after adjustment for clinical severity. Yield and short-term outcomes did not differ by language preference among imaged patients; however, imaging selection precludes conclusions about mechanism.