Related Experiment Video
Updated: Dec 16, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
A Standardized Protocol for Cervical Spine Evaluation in Children Reduces Imaging Utilization: A Pilot Study of the
Christopher Pennell1, Jayesh Gupta2, Michael March2
1Department of Pediatric General, Thoracic, and Minimally Invasive Pediatric Surgery.
Insights
A new protocol for pediatric cervical spine injuries significantly increased clinical exam clearance and reduced imaging studies and costs. This approach safely identifies cervical spine injuries in children, optimizing resource use.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Cervical spine injuries (CSIs) in children can lead to severe morbidity.
- Current evaluation methods involve multiple imaging studies, incurring significant financial and radiation costs.
- A standardized protocol was implemented to optimize CSI evaluation in pediatric patients.
Purpose of the Study:
- To assess the effectiveness of a standardized protocol for pediatric cervical spine injury clearance.
- To evaluate the impact of the protocol on imaging utilization and associated costs.
- To determine if the protocol reliably identifies CSIs while reducing resource expenditure.
Main Methods:
- A retrospective review of children under 18 with suspected CSIs at a Level 1 pediatric trauma center before and after protocol implementation.
- Data collected included demographics, injury details, and imaging utilization (X-ray, CT, MRI).
- Primary outcomes were clinical exam clearance rates and imaging proportions; secondary outcome was estimated cost reduction.
Main Results:
- The study included 359 children (248 pre-protocol, 111 post-protocol) with similar injury characteristics.
- Post-protocol implementation, children were significantly more likely to be cleared by clinical exam (43.2% vs. 15.3%).
- There was a significant reduction in X-ray and CT utilization, leading to an estimated annual cost saving of $396,476, without compromising injury detection.
Conclusions:
- The Pediatric Cervical Spine Clearance Working Group (PCSCWG) standardized protocol effectively reduces radiographic studies and associated costs in pediatric CSI evaluations.
- The protocol safely identifies cervical spine injuries, enhancing resource utilization.
- Implementation of standardized protocols can improve efficiency and cost-effectiveness in pediatric trauma care.
Background:
Cervical spine injuries (CSI) have the potential to cause severe morbidity in children. Multiple imaging studies are used during evaluation of CSIs but come at a cost, both financially and in radiation exposure. To reduce resource utilization and radiation exposure, we implemented the Pediatric Cervical Spine Clearance Working Group (PCSCWG) standardized protocol (SP) for evaluating CSIs in children.
Methods:
Children below 18 years old presenting with concern for CSI at a level 1 pediatric trauma center were reviewed before (July 2015 to May 2016) and after (November 2017 to June 2018) protocol implementation. Demographics, injuries, and imaging utilization were extracted. The primary outcomes were the proportion of patients cleared with clinical exam, and the proportion undergoing x-ray, computed tomography, or magnetic resonance image. The secondary outcome was the estimated difference in imaging charges based on the annual reduction in radiographic studies.
Results:
During the study 359 children were evaluated for CSIs (248 pre-SP, 111 post-SP). Patients were similar with respect to age, injury severity score, and mechanism of injury. Protocol adherence was 87.4%. The prevalence of CSI was similar in the preprotocol and postprotocol cohorts (2.8% vs. 1.8%, P=0.567). Children treated after protocol implementation were significantly more likely to be cleared by clinical exam (15.3% vs. 43.2%, P<0.001). Significantly fewer children had x-rays (70.2% vs. 55.0%, P=0.005) and computed tomography scans (14.5% vs. 5.4%, P=0.013) in the postprotocol period. There was no difference in the utilization of magnetic resonance image (6.9% vs. 7.2%, P=0.904) or the proportion of children discharged with a cervical collar (10.1% vs. 12.6%, P=0.476). No patients in either group were found to have a previously undiagnosed injury at follow-up. The reduction in radiographic studies translates to an estimated annual reduction in imaging charges of $396,476.
Conclusions:
The PCSCWG protocol for evaluating CSIs reduced the number of radiographic studies performed and estimated imaging charges while reliably identifying CSIs.
Related Concept Videos
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT