Balancing diagnostic accuracy and risk: Opportunities to reduce pediatric cervical spine CT utilization

Computed tomography (CT) imaging of the cervical spine is critical in pediatric trauma management but poses risks from radiation exposure and increases healthcare expenditure. This study quantified variations in cervical spine CT utilization among pediatric trauma patients within a statewide network comparing pediatric to adult hospital utilization.

A retrospective cohort study analyzed 25,996 pediatric trauma encounters (<18 years) between January 2012 and December 2023 across 23 hospitals in a statewide pediatric trauma network. Primary outcomes included hospital CT utilization rates and ratios of CT scans per clinically significant cervical spine injury (CSI). Secondary outcomes were X-ray (XR) and Magnetic Resonance Imaging (MRI) rates.

Of 25,996 encounters, 29 % (7610) occurred at the pediatric trauma center (PTC). Adult-oriented hospitals performed cervical spine CT scans more frequently (68.0 %, SD: 13.4 %) compared to the PTC (25.8 %, p = 0.005), equating to approximately 7770 potentially avoidable CT scans. Adult hospitals conducted approximately five times as many scans per CSI as the pediatric center (195 vs. 41 scans/injury).

Significant discrepancies exist in cervical spine CT utilization between pediatric and adult-oriented hospitals, leading to substantial unnecessary radiation exposure, malignancy risk, and resource utilization. Targeted interventions, including implementation of standardized imaging protocols and clinical decision tools, are needed to optimize pediatric trauma imaging practices.