TO SCAN OR NOT TO SCAN
Half a million children arrive at emergency rooms following minor head trauma each year, and almost half of them receive a CT scan of the brain. Because only rarely is the information gleaned from the CT valuable, a large number of children are getting radiation exposure. Who should get a scan remains a difficult joint doctor-parent decision. These authors randomized parents to receive either a guided conversation with pictures about concussion and how to think about the true risk of serious brain injury (called a decision aid) or to receive usual ER care. Providing parents with a clear decision aid improved parental knowledge, limited unnecessary follow-up CT scans, and involved parents more deeply in their child’s care.
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INFANT MORTALITY AND MEDICAID EXPANSION
Medicaid funds many maternal and child healthcare services in the United States, including 45% of births. Since the Affordable Care Act was implemented in 2014, 34 states have opted to expand their Medicaid programs. But some of the states with the largest proportions—54% to 72%—of births covered by Medicaid did not expand. As of 2016, several of those states, including Alabama and Mississippi, had the highest rates of infant mortality in the country at about 7.4 to 9.1 infant deaths for every 1000 live births.
Bhatt and Beck-Sagué compared infant death rates between states that expanded Medicaid coverage and those that did not. Average death rates among all infants decreased in states that expanded Medicaid, and increased in states that did not.
As shown in the Figure, Black infant mortality decreased overall from 2010 to 2015, but twice as much in Medicaid expansion states (a difference of 1.7 deaths per 1000 live births) compared to non-expansion states (a difference of 0.8 deaths per 1000 live births).
The researchers call for studies to further identify reasons why Medicaid expansion states had better infant outcomes, and what barriers to child health may exist in non-expansion states. —Sampada Nandyala, PHP Fellow
Graphic from “Medicaid Expansion and Infant Mortality in the United States,” Chintan B. Bhatt and Consuelo M. Beck-Sagué, American Journal of Public Health, April 2018, Vol 108, No. 4.
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