Parents Demand More Information on CT Cancer Risk in ED

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A recent study shows that more and more parents are inquiring about the associated cancer risk by undergoing a CT on their child in the emergency department (ED). However, this rarely stops parents from going through with the procedure, the study showed.

Around half of parents who were surveyed when their child was seen for a head injury in the ED were shown to have prior knowledge about the risk from ionizing radiation with CT scans (47%), Kathy Boutis, MD, of the University of Toronto and its Hospital for Sick Children, and her team discovered.

More than 90% of parents requested to be informed of possible malignancy risks before continuing with the scan. However, following the notification only 6% refused the CT all parents want more info on ct cancer risktogether, the team noted in the issue of Pediatrics.

The team also pointed out that the use of CT scans in the ED has risen five-fold, in spite of the high radiation dose, children are particularly susceptible to.

"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," added the authors.

The study involved 742 parents who were surveyed when their children (average age 4 years) were admitted to a pediatric care sector in the ED with an isolated head injury, before any suggestion of CT was made. Almost all children were diagnosed with a minor head-injury or concussion (97%).

And although 12% of the children had prior CT scans, 63% of parents undermined the lifetime risk of cancer from the imaging exam.

Parents thought the risk of a skull radiograph series resembles CT, although evidence from long-term research puts x-ray lower at one in 1,000,000 compared to one in 10,000.

"The latter could result in an inappropriately equal level of concern about radiation exposure and potential malignancy risks when a physician recommends radiographs or CT, which may affect how often parents raise verbal conversations about potential risks from CT," said Boutis.

"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."

Originally, 90% of parents said they were "very willing" or "willing" to carry on with a head CT if the emergency doctor deemed it necessary.

That figure significantly dropped to 70% (P<0.0001) after being told "it has been estimated that a head CT scan in a child may carry an increased lifetime cancer risk around one in 10,000. It is very important to remember that the information from a CT scan may help a doctor decide how to best care for a child."

Following disclosure, 35% said they would still go through with a CT if the physician decided it was important. While 41% requested further discussion with a physician.

Moreover, the 42 parents (6%) who refused CT testing in the survey based on the information of lifetime cancer risk, eight received a recommendation from the physician for CT imaging of their child, which they all obliged.

Shortcomings of the study included a lack of data on parents' experience with cancer and that the risk information given was brief and without a personal or detailed clinical context, which "may not reflect what would happen in clinical reality."

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