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A pediatric cervical spine clearance protocol to reduce radiation exposure in children
Raphael Sun1, Dionne Skeete, Kristel Wetjen
1Department of Surgery, Division of Acute Care Surgery and Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. raphaelsun@gmail.com
Insights
Implementing an age-specific cervical spine protocol significantly reduced computed tomography (CT) use and radiation exposure in children under 10 years old. This protocol decreased CT scans by 60% and thyroid radiation dose by over 80%.
Area of Science:
- Pediatric Traumatology
- Radiology
- Public Health
Background:
- Minimizing radiation exposure in pediatric patients is crucial.
- Resource utilization in trauma centers needs optimization.
- Cervical spine injuries in children require careful evaluation.
Purpose of the Study:
- To assess the impact of an age-specific algorithm on computed tomography (CT) utilization for pediatric cervical spine injuries.
- To quantify the reduction in radiation exposure following protocol implementation.
Main Methods:
- Retrospective review of pediatric patients (≤ 10 years) at a Level 1 trauma center.
- Comparison of pre-protocol and post-protocol groups (n=324).
- Analysis of CT use, radiation dose (using WinDose), and injury data.
Main Results:
- A 60% decrease in full CT scans was observed post-protocol (P < 0.001).
- Estimated 50% reduction in exposed area and >80% decrease in thyroid radiation dose.
- Overall threefold reduction in radiation exposure extrapolated.
Conclusions:
- An age-specific cervical spine protocol significantly reduces radiation exposure in children.
- The protocol effectively minimizes unnecessary CT imaging in pediatric trauma.
- This approach enhances patient safety and conserves resources.
Background:
To minimize radiation exposure in children and reduce resource use, we implemented an age-specific algorithm to evaluate cervical spine injuries at a Level 1 trauma center. The effects of protocol implementation on computed tomography (CT) use in children (≤ 10 y) were determined.
Methods:
With institutional review board approval, we conducted a retrospective review using the institutional trauma registry. All pediatric patients (≤ 10 y) (n = 324) between January 2007 and present were reviewed. We excluded cases in which no imaging or outside imaging was performed. Patients were evaluated by physical exam alone, with the aid of plain radiograms or with cervical spine CT. All patients who required head CT also had CT of cervical spine to C3. We analyzed demographic, injury, and outcome data using STATA to perform chi-square and t-test, and to determine P value. P < 0.05 was defined as significant. We used the WinDose program to calculate the radiation-effective dose used in cervical spine CT.
Results:
There were 123 and 124 patients in the pre-protocol and post-protocol groups, respectively. Demographics, GCS, and injury analysis, specifically head-neck and face Injury Severity Scores showed no significant difference between groups. There was a 60% (P < 0.001) decrease in the use of full CTs after protocol implementation. We estimated that the protocol reduced the exposed area by 50% and decreased the radiation dose to the thyroid by > 80%. We extrapolated the combined effect results in a threefold reduction in radiation exposure.
Conclusions:
Implementation of a cervical spine protocol led to a significant reduction in radiation exposure among children.
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