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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.
Insights
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.
Objective:
The emergent evaluation of children with suspected traumatic cervical spine injuries (CSI) remains a challenge. Pediatric clinical pathways have been developed to stratify the risk of CSI and guide computed tomography (CT) utilization. The cost-effectiveness of their application has not been evaluated. Our objective was to examine the cost-effectiveness of three common strategies for the evaluation of children with suspected CSI after blunt injury.
Methods:
We developed a decision analytic model comparing these strategies to estimate clinical outcomes and costs for a hypothetical population of 0-17 year old patients with blunt neck trauma. Strategies included: 1) clinical pathway to stratify risk using NEXUS criteria and determine need for diagnostic testing; 2) screening radiographs as a first diagnostic; and 3) immediate CT scanning for all patients. We measured effectiveness with quality-adjusted life years (QALYs), and costs with 2018 U.S. dollars. Costs and effectiveness were discounted at 3% per year.
Results:
The use of the clinical pathway results in a gain of 0.04 QALYs and a cost saving of $2800 compared with immediate CT scanning of all patients. Use of the clinical pathway was less costly and more effective than immediate CT scan as long as the sensitivity of the clinical prediction rule was greater than 87% and when the sensitivity of x-ray was greater than 84%.
Conclusion:
A strategy using a clinical pathway to first stratify risk before further diagnostic testing was less costly and more effective than either performing CT scanning or screening cervical radiographs on all patients.
