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Cervical spine computed tomography utilization in pediatric trauma patients

Kathleen M Adelgais1, Lorin Browne2, Maija Holsti3

  • 1Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO.

Journal of Pediatric Surgery
|February 18, 2014
PubMed

Insights

Cervical spine CT (CSCT) use increased significantly in pediatric trauma patients over a decade, particularly in general emergency departments (GEDs) compared to pediatric trauma centers (PTCs). This rise occurred despite stable rates of cervical spine injury (CSI).

Area of Science:

  • Pediatric Emergency Medicine
  • Radiology
  • Trauma Surgery

Background:

  • Pediatric trauma guidelines recommend cervical spine CT (CSCT) for suspected injuries on plain radiographs.
  • Variations in CSCT utilization between specialized pediatric trauma centers (PTCs) and general emergency departments (GEDs) are not well understood.

Purpose of the Study:

  • To compare the utilization rates of CSCT between PTCs and GEDs for pediatric trauma patients.
  • To identify factors associated with CSCT use in this population.

Main Methods:

  • Analysis of a pediatric trauma registry from 2002 to 2011.
  • Comparison of CSCT and cervical spine injury (CSI) rates in PTCs versus GEDs.
  • Multivariate logistic regression to assess factors influencing CSCT use.

Main Results:

  • Over 5100 patients were analyzed; GED patients had higher injury severity scores and ICU admission rates.
  • The overall CSI rate remained stable at 2.1%.
  • CSCT utilization increased significantly over time in both settings, with notably higher and increasing rates in GEDs (6.8% to 42.0%) compared to PTCs (3.5% to 16.1%).

Conclusions:

  • Despite stable CSI rates, CSCT utilization has markedly increased in pediatric trauma care.
  • Initial evaluation at a GED is strongly associated with higher CSCT use.
  • Further research may be needed to optimize CSCT utilization guidelines in pediatric trauma.
Abstract

Keywords:
Computed tomographyPediatricTrauma

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