Implementation of a pediatric trauma cervical spine clearance pathway
Natalie C Luehmann1, Jacquelyn M Pastewski1, Jennifer A Cirino1
1Department of Surgery, Beaumont Health, Royal Oak, MI, USA.
Insights
Implementing a standardized cervical spine clearance pathway in pediatric trauma care reduced imaging and consultations. This approach safely cleared more patients clinically, optimizing resource use without compromising injury detection.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Pediatric cervical spine injuries are rare, necessitating careful consideration of imaging risks versus benefits.
- A standardized algorithm for pediatric cervical spine clearance is lacking, leading to variable care practices.
- Evaluating care improvements after implementing a standardized pathway is crucial for optimizing pediatric trauma management.
Purpose of the Study:
- To assess the impact of a standardized cervical spine clearance pathway on pediatric trauma care.
- To evaluate changes in imaging rates, length of stay, specialist consultations, and injury detection.
- To determine if a standardized pathway improves resource utilization and patient outcomes.
Main Methods:
- A multidisciplinary team developed a pediatric cervical spine clearance algorithm based on literature review.
- Patient charts were retrospectively reviewed for 15 months before and after pathway implementation.
- Statistical analysis, including Chi-square tests, was used to compare pre- and post-implementation data (p < 0.05).
Main Results:
- No significant differences in demographics, injury mechanism, or severity were observed between groups.
- Post-implementation, there was a significant decrease in cervical spine radiographs (34% to 16%) and spine consultations (28% to 13%).
- Clinical clearance rates increased significantly (44% to 62%), with no increase in missed injuries.
Conclusions:
- A standardized cervical spine clearance pathway effectively increases clinical clearance rates in pediatric trauma patients.
- The pathway optimizes resource utilization by reducing unnecessary imaging and consultations.
- Implementation of the standardized pathway ensures patient safety without compromising the detection of cervical spine injuries.
Purpose:
Pediatric cervical spine injuries are rare events. Missed injuries must be weighed against radiation exposure and excess resource utilization in a young population. A universal pediatric cervical spine clearance algorithm does not exist. The study objective is to determine if care improved after the implementation of a standardized cervical spine clearance pathway by evaluating imaging rates, length of stay, speciality consultation, and injury detection.
Methods:
A multidisciplinary group reviewed relevant literature to develop an algorithm for cervical spine clearance in pediatric trauma patients. We reviewed patient charts 15 months before and after implementation. Categorical comparisons were tested with Chi-square. A p value less than 0.05 was considered statistically significant.
Results:
The pre- and post-implementation groups were homogenous when comparing demographics, mechanism and severity of injury. Using the cervical spine clearance pathway, patients received fewer plain cervical spine radiographs (34% vs 16%), fewer spine speciality consults (28% vs 13%), and more patients were cleared clinically (44% vs 62%) (p < 0.05). There were 2 (1.7%) documented injuries in the pre-implementation group and 3 (3%) documented injuries in the post-implementation group. There were no missed injuries.
Conclusions:
Use of a standardized pathway allows more patients' cervical spines to be cleared clinically and better utilizes resources without compromising patient care.
Level Of Evidence:
Level III.
Type Of Study:
Care Management Study.
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