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Cervical spine imaging in hospitalized children with traumatic brain injury
Tellen D Bennett1, Susan L Bratton, Jay Riva-Cambrin
1From the *Departments of Pediatric Critical Care, †Pediatric Neurosurgery, and ‡Pediatric Surgery, University of Utah, Primary Children's Medical Center, Salt Lake City, UT; §Department of Pediatric Surgery, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; and Departments of ∥Pediatric Radiology, Primary Children's Medical Center and ¶Pediatrics, University of Utah, Salt Lake City, UT.
Insights
Cervical spine imaging in children with traumatic brain injury (TBI) has shifted from radiographs to computed tomography (CT). This trend persists even in low-risk pediatric TBI cases, raising concerns about radiation exposure.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Traumatic brain injury (TBI) in children necessitates careful evaluation, including assessment for associated cervical spine injuries.
- Current imaging practices for pediatric cervical spine injuries are evolving, influenced by adult protocols and technological advancements.
Purpose of the Study:
- To describe and assess changes in cervical spine imaging practices for children with TBI between 2001 and 2011.
- To determine the utilization of cervical spine computed tomography (CT) in low-risk pediatric TBI patients.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System database (2001-2011).
- Inclusion of children under 18 with TBI who received a head CT scan on admission.
- Primary outcome measures focused on cervical spine imaging studies performed.
Main Results:
- Over 30,000 children with TBI were analyzed; 52% received cervical spine imaging.
- Cervical spine radiograph use decreased significantly (47% to 23%), while CT use increased (8.6% to 19.5%).
- 2545 children underwent cervical spine CT, with 1655 having a low-risk mechanism of injury.
Conclusions:
- Adult CT clearance protocols for cervical spine injuries appear to influence pediatric TBI management.
- Increased use of CT in pediatric TBI raises concerns regarding radiation exposure in this population.
Objectives:
The purposes of this study, in children with traumatic brain injury (TBI), to describe cervical spine imaging practice, to assess for recent changes in imaging practice, and to determine whether cervical spine computed tomography (CT) is being used in children at low risk for cervical spine injury.
Methods:
The setting was children's hospitals participating in the Pediatric Health Information System database, from January 2001 to June 2011. Participants were children (younger than 18 y) with TBI who were evaluated in the emergency department, admitted to the hospital, and received a head CT scan on the day of admission. The primary outcome measures were cervical spine imaging studies. This study was exempted from institutional review board assessment.
Results:
A total of 30,112 children met study criteria. Overall, 52% (15,687/30,112) received cervical spine imaging. The use of cervical spine radiographs alone decreased between 2001 (47%) and 2011 (23%), with an annual decrease of 2.2% (95% confidence interval [CI], 1.1%-3.3%), and was largely replaced by an increased use of CT, with or without radiographs (8.6% in 2001 and 19.5% in 2011, with an annual increase of 0.9%; 95% CI, 0.1%-1.8%). A total of 2545 children received cervical spine CT despite being discharged alive from the hospital in less than 72 hours, and 1655 of those had a low-risk mechanism of injury.
Conclusions:
The adoption of CT clearance of the cervical spine in adults seems to have influenced the care of children with TBI, despite concerns about radiation exposure.
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