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Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre
Annelie Slaar1, M Matthijs Fockens1, Rick R van Rijn1
1Department of Radiology, The Netherlands.
Insights
Pediatric cervical spine (C-spine) imaging adherence is high for indications but shows deficits in the number of radiographs obtained. This study evaluated guideline adherence for C-spine clearance in children following trauma.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Evidence-Based Medicine
Background:
- International guidelines exist for pediatric cervical spine (C-spine) radiography after trauma.
- Adherence to these guidelines in pediatric populations has not been previously assessed.
- Evaluating adherence is crucial for optimizing imaging practices in trauma centers.
Purpose of the Study:
- To assess adherence to international guidelines for C-spine clearance in children.
- To evaluate both the indication and the type of radiography used.
- To identify areas for improvement in pediatric trauma imaging protocols.
Main Methods:
- Retrospective review of pediatric patients undergoing C-spine radiography after blunt trauma.
- Inclusion criteria: ED presentation, January 2006-December 2013.
- Primary outcomes: Correct indication for imaging and correct type of imaging modality used.
Main Results:
- 100% adherence to guidelines for the indication of C-spine radiography.
- 99.7% concordance with guidelines for the primary imaging modality.
- 56% of patients did not receive the recommended number of radiographs, with incomplete sets in 15%.
Conclusions:
- Adherence to guidelines for initiating pediatric C-spine radiography is excellent.
- A significant proportion of pediatric trauma patients receive an incomplete set of C-spine radiographs.
- Opportunities exist to improve the completeness of C-spine imaging in pediatric trauma care.
Introduction:
International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine clearance in a level-one trauma centre.
Methods:
We retrospectively included all children, presented at the ED between January 2006 and December 2013, in whom radiographic imaging of the C-spine was obtained following blunt trauma. Primary outcome was the adherence to the international guidelines with regard to (1) if the indication for radiographic imaging was correct and (2) if the type of radiographic imaging was correct.
Results:
Included were 573 patients; 336 boys (58.7%). Median age was 11 years (IQR 5.25-15). The indication for radiographic imaging was correct in all cases. The type of primary imaging modality was concordant with the guidelines in 99,7%. In 41% of the cases supplementary radiographs were made. The most common supplementary view was the odontoid. In 15% an incomplete set of radiographs was obtained.
Conclusion:
The adherence to the international guidelines when to obtain radiographic imaging was 100%. However, in a large proportion of patients (56%), not the recommended number of radiographs was obtained.
