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Implementation of pediatric cervical spine clearance guidelines at a combined trauma center: Twelve-month impact
Shannon F Rosati1, Rami Maarouf, Luke Wolfe
1From the Division of Pediatric Surgery (S.F.R., R.M., D.P., J.H.) and Department of Surgery (L.W.), School of Medicine (M.P., R.M., K.B.), and Children's Trauma Center, Children's Hospital of Richmond (J.H.H.), Virginia Commonwealth University Health System, Richmond, Virginia.
Background:
Pediatric cervical spine clearance guidelines should reduce computed tomography (CT) usage in combined pediatric and adult trauma centers biased by adult CT clearance.
Methods:
Cervical spine clearance under age 15 years was compared 12 months before (128 patients) and after (105 patients) guideline implementation, emphasizing National Emergency X-Radiography Utilization Study (NEXUS) criteria when appropriate.
Results:
CT scans in patients clearable by NEXUS criteria decreased 23% (p = 0.01) and decreased by 16% in cases where radiography other than CT was indicated by guidelines (p = 0.01).
Conclusion:
Guideline implementation can have an immediate effect in decreasing pediatric cervical spine CT usage and should improve across time.
Level Of Evidence:
Care management study, level IV.
