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Reducing radiation exposure in pediatric cervical spine imaging for trauma: a multi-disciplinary quality improvement
Nina Yu1, Jonathan Emerson Kohler2, Kendra Grether-Jones3
1University of California, Davis, School of Medicine, Sacramento, CA, 95817, USA.
Insights
A new protocol significantly reduced unnecessary CT scans for pediatric cervical spine injuries, lowering inappropriate use from 58.6% to 6.8%. This improves safety by reducing radiation exposure in pediatric trauma patients.
Area of Science:
- Pediatric Traumatology
- Radiology and Imaging
- Evidence-Based Medicine
Background:
- Pediatric cervical spine injury (PCSI) is a critical concern, potentially leading to severe neurological deficits.
- Computed tomography (CT) is effective for diagnosing PCSI but carries risks of ionizing radiation exposure.
- A prior audit indicated a high rate (54%) of inappropriate CT utilization in pediatric trauma patients.
Purpose of the Study:
- To evaluate the impact of an updated institutional protocol on reducing radiation exposure in pediatric trauma patients.
- To assess changes in computed tomography (CT) utilization and guideline adherence following protocol implementation.
Main Methods:
- Retrospective analysis of data from a pediatric level 1 trauma center (2021-2022).
- Two cohorts were compared: pre-implementation (2021) and post-implementation (2022).
- Inclusion criteria: patients aged 0-14 years with Glasgow Coma Scale (GCS) 9-15; exclusion: outside-hospital transfers.
Main Results:
- The study included 82 subjects (38 in 2021, 44 in 2022).
- Protocol adherence increased from 81.6% in 2021 to 93.2% in 2022 (p=0.109).
- Inappropriate CT utilization decreased significantly from 58.6% to 6.8% (p<0.05) post-implementation.
Conclusions:
- Implementing an evidence-based protocol for PCSI improved adherence and reduced unnecessary CT orders.
- The updated protocol effectively decreased inappropriate CT use, thereby mitigating radiation exposure.
- Continued monitoring is recommended to ensure the sustained effectiveness of the protocol.
Purpose:
Pediatric cervical spine injury (PCSI) can result in devastating neurologic disability. While computed tomography (CT) imaging is both sensitive and specific in detecting clinically significant injuries, indiscriminate utilization can lead to excessive ionizing radiation exposure. A routine institutional audit revealed CTs were inappropriately obtained 54% of the time. This study evaluates the effects of an updated protocol to reduce radiation exposure in pediatric trauma patients.
Methods:
Data were retrospectively analyzed from a pediatric level 1 trauma center from 2021 to 2022. The data were divided into two cohorts, pre-implementation (2021) and post-implementation (2022). Inclusion criteria were patients 0-14 years old with a Glasgow Coma Scale (GCS) ranging 9-15. Outside-hospital transfers were excluded. The primary study endpoints were guideline compliance and CT utilization.
Results:
A total of 82 subjects were enrolled in this study. In 2021, there were 38 subjects (female/male 15/23, mean age 5.9 years old) with an average GCS of 13.6. In 2022, there were 44 subjects (female/male 19/25, mean age 5.2 years old) with an average GCS of 14.0. In 2021, the overall protocol adherence rate was 81.6%, and post-implementation in 2022, compliance was 93.2% (p = 0.109). Following implementation, the rate of inappropriate (protocol non-adherent CT) use decreased from 58.6 to 6.8% (p < 0.05).
Conclusions:
Implementation of a new evidence-based institutional protocol for PCSI was associated with improved adherence and reduction of unnecessary CT orders. Ongoing monitoring will help determine if these improvements are sustained.
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