Racial Disparities in Early Evaluation and Management of Patients with Non-Syndromic Craniosynostosis
Casey Tompkins-Rhoades, BS1, Erin Anstadt, MD2, Fady Paul Marji, MD2, Jesse Goldstein, MD2.
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background:Craniosynstosis is a congenital skull deformity that results from the premature fusion of the bony plates of an infantís skull. Untreated, this condition can lead to intracranial hypertension, cognitive impairment, vision problems, and abnormal speech and hearing. These sequelae can be abated or avoided with early recognition of symptoms and referral for intervention. The project aims to analyze the evaluation and management of patients with suspected craniosynostosis in order to address any disparities in age at diagnostic imaging or surgical intervention that may exist between patients that identify as white or African-American/Black.
Methods:A retrospective chart review of patients with suspected craniosynostosis who were evaluated between 2012 and 2017 within the Division of Pediatric Plastic Surgery at a tertiary care hospital was completed. Demographic, radiologic, and surgical intervention data were recorded. Outcomes assessed include age at computed tomography (CT) imaging and age at definitive treatment. Descriptive statistics were performed to analyze differences observed in Black or African-American patients compared to their white counterparts.
Results:A total of 277 patients were evaluated by a plastic surgeon. Of the patients who received a head CT, n=132 (67%) patients were white and n=65 (33%) identified as Black or African-American. There was a statistically significant difference in mean age at first head CT between white and Black or African-American patients, 2.279 years versus 3.854 years respectively (p=0.0013). For the Black or African-American patients that went on to receive surgical intervention (n=22, 28%), the mean age at the time of surgery was 2.514 years and mean age at time of first head CT was 2.636 years. For Caucasian patients that went on to receive surgery (N=57, 72%), mean age at first head CT was 1.719 years and mean age at first surgery was 1.622 years. No significant difference was detected in average age at surgical intervention between the two cohorts (p=0.1340).
Conclusions:Black or African-American patients experience a delay in diagnostic imaging with the average age at the time of first head CT being almost double that of their white counterparts. The data suggest that black patients may experience this delay in diagnosis because they suffer from a phenotypically milder form of the condition that does not require surgical intervention. A disparity exists because this population still requires close follow up for the development of serious complications, whereas white children are being detected, referred, and monitored at earlier ages.
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