Variation in the Self-Reported Use of Computed Tomography in Clearing the Cervical Spine of Pediatric Trauma Patients
ABSTRACT Cervical spine injury (CSI) in children can be life-threatening or associated with lifelong disabilities. Whereas screening computed tomography (CT) of the cervical spine is used in the evaluation of adult trauma patients, it has no additional benefit in children when compared with plain film radiography of the cervical spine. Despite this, CT use in the pediatric patient is increasing. We sought to compare the self-reported utilization of screening cervical spine CT among pediatric emergency medicine (PEM) physicians and general emergency medicine (non-PEM) physicians.
Physicians completed an online survey consisting of a clinical vignette in which the respondents chose to evaluate a pediatric trauma patient for CSI using no imaging, plain films, or CT. Questions regarding the physician's attitudes, knowledge, and practice patterns for pediatric CSI were included.
Six hundred fifty-four physicians responded to the survey: 463 (70.8%) non-PEM and 191 (29.2%) PEM physicians. Both groups ordered radiographic imaging at a similar rate, although non-PEM physicians were 4 times more likely to utilize CT than PEM practitioners. Non-PEM physicians were more likely to overestimate the frequency of pediatric CSI. Pediatric emergency medicine physicians were more likely to state that they would never use CT as the initial modality for CSI screening.
In response to a clinical vignette, non-PEM physicians were more likely to self-report the use of screening CT in pediatric trauma patients than PEM physicians.
SourceAvailable from: Kathleen M Adelgais[Show abstract] [Hide abstract]
ABSTRACT: Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs). Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression. 5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p<0.05) and more frequent ICU admissions (44.3% vs. 26.1% p<0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI=8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI=25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT. Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.Journal of Pediatric Surgery 02/2014; 49(2):333-7. DOI:10.1016/j.jpedsurg.2013.10.006 · 1.31 Impact Factor
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ABSTRACT: A variety of radiologic screening protocols exist for evaluation of pediatric trauma patients with potential cervical spine (c-spine) injuries. The purpose of this study was to describe findings on c-spine magnetic resonance imaging (MRI) after previously normal c-spine computed tomographic (CT) scan findings at a Level 1 trauma center. A retrospective chart review of trauma patients evaluated at Rady Children's Hospital, San Diego, between January 2000 and February 2010 was conducted. Trauma patients who were younger than 18 years, placed in c-spine precautions, had a normal c-spine CT scan, who subsequently had a c-spine MRI were included. The sample was subdivided into patients who underwent CT scans between January 1, 2000 to July 31, 2005 (early group), and August 1, 2005 to February 28, 2010 (late group), to compare results between different CT scan resolutions. A total of 173 patients met inclusion criteria. With 100% of patients demonstrating normal c-spine CT scan findings, 83% of c-spine MRI findings were also negative (p < 0.001). Thirty patients (17%) demonstrated significant abnormalities on MRI. Of the 30, 5 (2.9%) required operative c-spine stabilization. Eighty-five patients underwent CT scan in the early group, and 88 in the late group. All 5 patients with unstable injuries not discovered on CT scan were from the early group, compared with none in the late group (p = 0.027). Our results suggest that high-resolution CT scan with sagittal and coronal reconstructions may be comparable with MRI for the detection of unstable c-spine injuries in pediatric trauma patients. Although minimizing CT scan radiation exposure remains essential, high-resolution c-spine CT scan may allow for earlier c-spine clearance with reduction of associated hard collar comorbidities in centers where MRI is not available or in situations where the patient's clinical stability precludes obtaining MRI. Diagnostic study, level III.04/2013; 74(4):1102-7. DOI:10.1097/TA.0b013e3182827139