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Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre
Joost G Ten Brinke1,2, Geertruida Slinger3, Annelie Slaar4
1Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. j.g.tenbrinke-2@umcutrecht.nl.
Insights
Pediatric cervical spine injury is rare after blunt trauma. While protocol adherence for imaging indications is high, CT scan use increased inappropriately. Stricter adherence and predictive rules are needed to avoid overuse of imaging.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Cervical spine injuries in children following blunt trauma are infrequent but carry significant risks.
- Standardized diagnostic workup protocols for pediatric cervical spine injuries are currently lacking.
- This study aimed to assess the incidence of such injuries and adherence to imaging protocols at a Level 2 trauma center.
Purpose of the Study:
- To determine the incidence of cervical spine injury in children after blunt trauma.
- To evaluate adherence to established imaging protocols for pediatric cervical spine assessment.
- To identify trends in imaging modality usage, particularly CT scans.
Main Methods:
- Retrospective analysis of pediatric patients (<16 years) with suspected cervical spine injury after blunt trauma.
- Data collected from two distinct periods (Jan 2010-Jun 2012 and Jan 2017-Jun 2019) separated by a protocol update.
- Outcomes measured included injury incidence and protocol adherence for imaging indications and modality selection.
Main Results:
- A total of 253 children were analyzed (170 in the first period, 83 in the second).
- Only one case of cervical spine injury was diagnosed across both periods.
- Protocol adherence for imaging indications exceeded 80% in both periods, but adherence to imaging type decreased, with a significant rise in primary CT scan use in the second period (45.8% vs. 2.9%).
Conclusions:
- Radiographic imaging is commonly employed for pediatric cervical spine clearance despite the rarity of injury.
- There has been an inappropriate increase in the use of CT scans over time.
- Improved adherence to imaging protocols can reduce overuse, but a validated clinical decision rule is essential to identify children truly at risk.
Purpose:
Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre.
Methods:
We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging.
Results:
We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first.
Conclusion:
Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
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