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Cervical spine evaluation in pediatric trauma: A cost-effectiveness analysis
Kevin M Overmann1, Bryce R H Robinson2, Mark H Eckman3
1Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, USA; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA.
Using a clinical pathway to evaluate children with suspected traumatic cervical spine injuries is more cost-effective than immediate CT scans or radiographs. This approach saves money and improves outcomes for pediatric blunt neck trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Radiology
Background:
- Evaluating children with suspected traumatic cervical spine injuries (CSI) is challenging.
- Pediatric clinical pathways exist to guide computed tomography (CT) use but their cost-effectiveness is unknown.
- Blunt neck trauma in children requires careful diagnostic evaluation.
Purpose of the Study:
- To examine the cost-effectiveness of three strategies for evaluating pediatric CSI after blunt injury.
- Compare clinical pathways, screening radiographs, and immediate CT scanning.
- Determine the optimal approach for resource allocation in pediatric trauma care.
Main Methods:
- A decision analytic model was developed to compare three evaluation strategies.
- The model assessed clinical outcomes (QALYs) and costs in U.S. dollars for pediatric patients (0-17 years) with blunt neck trauma.
- Costs and effectiveness were discounted at 3% annually.
Main Results:
- The clinical pathway strategy yielded a gain of 0.04 QALYs and saved $2800 compared to immediate CT scanning.
- The clinical pathway was more cost-effective than immediate CT scanning if its sensitivity exceeded 87%.
- The clinical pathway was also more cost-effective than screening radiographs if x-ray sensitivity exceeded 84%.
Conclusions:
- A clinical pathway strategy for risk stratification is less costly and more effective than universal CT scanning or radiography for children with suspected CSI.
- This approach optimizes diagnostic testing and resource utilization in pediatric blunt trauma.
- Clinical pathways offer a superior cost-effectiveness profile for managing pediatric cervical spine injuries.
