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Variation in pediatric cervical spine imaging across trauma centers-A cause for concern?
Roxanne Massoumi1, Joseph Wertz, Tuyen Duong
1From the Division of Pediatric Surgery (R.M., J.W., H.C.-H.J.), Mattel Children's Hospital at University of California Los Angeles; and Division of General Internal Medicine and Health Services Research (T.D., C.-H.T.), University of California Los Angeles, Los Angeles, California.
Insights
Pediatric trauma centers use less advanced cervical spine imaging like CT scans, favoring X-rays. This variability highlights the need for standardized pediatric cervical spine evaluation guidelines.
Area of Science:
- Trauma Surgery
- Pediatric Radiology
- Emergency Medicine
Background:
- Pediatric cervical spine injuries present diagnostic challenges, with differing clinical algorithms compared to adults.
- Imaging decisions for pediatric trauma patients can vary based on physician experience and center specialization.
Purpose of the Study:
- To investigate variations in pediatric posttraumatic cervical spine imaging rates across different trauma centers.
- To determine if specialized trauma centers utilize advanced imaging less frequently.
Main Methods:
- Analysis of the 2015-2016 Trauma Quality Improvement Program database for pediatric patients (<18 years).
- Assessment of cervical spine imaging rates (CT, MRI, X-ray) at various trauma center levels.
- Propensity stratification logistic regression controlling for patient and center variables.
Main Results:
- Over 110,000 pediatric trauma patients were analyzed; 3.6% received cervical spine CT, <1% received MRI or X-ray.
- Level I trauma centers showed lower rates of cervical spine CT for younger patients but higher rates of MRI for those ≤14 years.
- Pediatric-designated trauma centers had significantly lower rates of CT and higher rates of X-ray and MRI (for younger patients).
Conclusions:
- Level I and pediatric trauma center designations correlate with reduced cervical spine CT use.
- Pediatric centers more frequently employ cervical spine X-rays, indicating imaging practice variability.
- Dissemination of pediatric-specific cervical spine evaluation guidelines is crucial to standardize care.
Background:
Traumatic pediatric cervical spine injury can be challenging to diagnose, and the clinical algorithms meant to aid physicians differ from adult trauma protocols. Despite the existence of standardized guidelines, imaging decisions may vary according to physician education, subjective assessment, and experience with pediatric trauma patients. Our study investigates the rates of pediatric posttraumatic cervical spine imaging across trauma centers, hypothesizing that more specialized centers will have lower rates of advanced cervical spine imaging.
Methods:
The 2015 to 2016 Trauma Quality Improvement Program database was reviewed for patients younger than 18 years- to assess rates of cervical spine imaging on presentation across different trauma centers. Propensity stratification logistic regression was performed controlling for patient- and center-specific variables. p Values less than 0.05 were considered significant.
Results:
Of 110,769 pediatric trauma patients, 35.2% were female, and the average age was 9.6 years. Overall, 3.6% had cervical spine computed tomography (CT) and less than 1% had cervical spine MRI or X-ray. Compared with all others, Level I trauma centers were significantly less likely to use cervical spine CT for the initial evaluation of younger (≤14 years) but not older trauma patients (adjusted odds ratio [AOR], 0.89; 95% confidence interval [CI], 0.80-0.99; AOR, 0.97; 95% CI, 0.87-1.09); Level I centers had higher odds of cervical spine MRI use, but only for patients 14 years or younger (AOR, 1.63; 95% CI, 1.09-2.44). Pediatric-designated trauma centers had significantly lower odds of cervical spine CT (≤14 years: AOR, 0.70; 95% CI, 0.63-0.78; >14 years: AOR, 0.67; 95% CI, 0.67-0.75) and higher odds of cervical spine X-ray (≤14 years: AOR, 4.75; 95% CI, 3.55-6.36; >14 years: AOR, 4.50; 95% CI, 2.72-7.45) for all ages, but higher odds of cervical spine MRI for younger patients only (≤14 years: AOR, 2.10; 95% CI, 1.38-3.21).
Conclusion:
Level I and pediatric designations were associated with lower rates of cervical spine CT. Pediatric centers were also more likely to use cervical spine X-ray. This variability of imaging use further supports the need to disseminate and educate providers on pediatric-specific cervical spine evaluation guidelines.
Level Of Evidence:
Prognostic and epidemiological, level III.
