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Decision-making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency
Megan E Gregory1, Annie Truelove2, Fahd Ahmad3
1Department of Health Outcomes and Biomedical Informatics University of Florida Gainesville Florida USA.
Insights
Implementing a risk assessment tool for pediatric cervical spine imaging requires addressing inter-specialty conflicts and improving team trust. Clearer roles and policies are needed for effective adoption in trauma care.
Area of Science:
- Pediatric Trauma Care
- Medical Decision-Making
- Healthcare Team Dynamics
Background:
- Cervical spine imaging in pediatric trauma is complex and varies widely.
- Risk assessment tools can standardize decisions and reduce radiation exposure.
- Understanding emergency department (ED)-trauma team dynamics is crucial for tool implementation.
Purpose of the Study:
- To investigate how ED-trauma team dynamics influence the implementation of a cervical spine imaging risk assessment tool for pediatric patients.
- To identify barriers and facilitators to adopting standardized decision-making processes.
Main Methods:
- Qualitative study involving interviews with 48 physicians and nurses across 21 hospitals in three US regions.
- Data collected from pediatric emergency physicians, general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons, and ED nurses.
- Framework-driven deductive coding and thematic analysis were used to analyze interview data.
Main Results:
- Emergency physicians and trauma surgeons often conflict over balancing injury detection versus radiation avoidance.
- Lack of trust and unclear role ownership for imaging decisions were reported.
- Nurses experienced low psychological safety, hindering their participation in decision-making.
Conclusions:
- Standardized risk assessment tool implementation for pediatric cervical spine trauma requires considering emergency medicine and trauma perspectives.
- Policies are needed to define appropriate use of these tools within the complex team environment.
- Addressing inter-specialty conflicts and fostering psychological safety are key for successful implementation.
Objective:
Cervical spine imaging decision-making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department-trauma team dynamics may affect implementation of such a tool.
Methods:
We interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision-making process. Data were coded following a framework-driven deductive coding process and thematic analysis was used.
Results:
Forty-eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I-III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision-making process.
Conclusions:
Implementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.
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