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Trends and variation in cervical spine imaging utilization across children's hospitals for pediatric trauma
Erin E Ross1, Shadassa Ourshalimian, Ryan G Spurrier
1From the Keck School of Medicine (E.E.R.), Division of Pediatric Surgery, Department of Surgery (S.O., R.G.S.), and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
Insights
Pediatric cervical spine (c-spine) imaging increased from 2015-2020, with significant hospital variation. This highlights the need for a standardized pediatric c-spine evaluation algorithm to optimize diagnostic resource use.
Area of Science:
- Pediatric Traumatology
- Diagnostic Imaging
- Health Services Research
Background:
- Cervical spine (c-spine) evaluation is crucial in pediatric trauma care.
- Existing pediatric c-spine algorithms lack widespread implementation.
- This study analyzes trends and variations in pediatric c-spine imaging practices.
Purpose of the Study:
- To assess temporal trends in c-spine imaging use across children's hospitals.
- To evaluate interinstitutional variations in imaging modalities (radiographs vs. CT).
- To examine the timing of magnetic resonance imaging (MRI) in admitted pediatric trauma patients.
Main Methods:
- Utilized data from the Children's Hospital Associations Pediatric Health Information System (2015-2020).
- Included pediatric patients (<18 years) with trauma and c-spine imaging (radiograph or CT) in the ED.
- Employed descriptive statistics and linear regression to analyze imaging use rates and trends.
Main Results:
- C-spine CT use increased from 28.5% to 36.5% between 2015 and 2020 across 35 hospitals.
- Significant interinstitutional variation observed in the choice between plain radiographs and CT for initial c-spine evaluation.
- Delayed MRI (>3 days post-admission) occurred in 31.5% of intensive care patients.
Conclusions:
- The rising use of CT and inconsistent imaging practices underscore the need for a standardized, age-specific pediatric c-spine evaluation algorithm.
- Implementation of such an algorithm can guide judicious use of diagnostic resources.
- Addressing interinstitutional variability and optimizing MRI timing are key areas for improvement.
Background:
Cervical spine (c-spine) evaluation is a critical component in trauma evaluation, and although several pediatric c-spine evaluation algorithms have been developed, none have been widely implemented. Here, we assess rates of c-spine imaging use across children's hospitals, specifically temporal trends in imaging use, variation across hospitals in imaging used, and timing of magnetic resonance imaging in admitted patients.
Methods:
Data from the Children's Hospital Associations Pediatric Health Information System were abstracted from 2015 to 2020. Patients younger than 18 years seen in the emergency department with an International Classification of Diseases, Tenth Revision , code indicative of trauma and c-spine plain radiograph or computed tomography (CT) in the emergency department were included. Data visualization and descriptive statistics were used to assess rates of imaging use by age, year, hospital, injury severity, and day of service. Changes in rates of imaging use over time were evaluated via simple linear regression.
Results:
Across 25,238 patient encounters at 35 children's hospitals, there was an increase in use of c-spine CT from 2015 to 2020 (28.5-36.5%). There was substantial interinstitutional variation in rates of use of plain radiographs versus CT for initial evaluation of the c-spine across all age groups. Magnetic resonance imaging was obtained more than 3 days after admission in 31.5% of intensive care patients who received this imaging.
Conclusion:
Increasing use of CT, substantial interinstitutional variation in rates of use of plain radiographs versus CT, and heterogenous timing of magnetic resonance imaging for evaluation of the pediatric c-spine demonstrate the growing need for development and implementation of an age-specific c-spine evaluation algorithm to guide judicious use of diagnostic resources.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
