Cervical spine computed tomography utilization in pediatric trauma patients

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.