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

Zachary J Moore1, Anastasia M Kahan1, Hsuan-Yu Wan2

  • 1Division of Pediatric Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States.

Journal of Pediatric Surgery
|November 7, 2025
PubMed

Insights

Adult hospitals overuse cervical spine CT scans in pediatric trauma cases, leading to radiation exposure and higher costs. Standardized protocols are needed to reduce unnecessary imaging and improve patient safety.

Area of Science:

  • Radiology
  • Pediatric Trauma Care
  • Health Services Research

Background:

  • Cervical spine computed tomography (CT) is vital for pediatric trauma but carries radiation risks and costs.
  • Variations in CT utilization exist between pediatric and adult trauma centers.
  • This study addresses disparities in cervical spine CT use for pediatric trauma patients.

Purpose of the Study:

  • To quantify and compare cervical spine CT utilization rates in pediatric trauma patients across a statewide network.
  • To analyze CT scan frequency relative to clinically significant cervical spine injuries (CSIs).
  • To identify potential overuse of CT imaging in adult-oriented hospitals compared to pediatric trauma centers.

Main Methods:

  • Retrospective cohort study of 25,996 pediatric trauma encounters (age <18) from January 2012 to December 2023.
  • Data collected from 23 hospitals within a statewide pediatric trauma network.
  • Compared CT utilization rates and CT scans per CSI between pediatric trauma centers and adult-oriented hospitals.

Main Results:

  • Adult-oriented hospitals performed cervical spine CT scans more frequently (68.0%) than the pediatric trauma center (25.8%).
  • An estimated 7770 potentially avoidable CT scans were identified in adult-oriented hospitals.
  • Adult hospitals performed approximately five times more CT scans per CSI than the pediatric center (195 vs. 41).

Conclusions:

  • Significant disparities in cervical spine CT utilization exist between pediatric and adult-oriented hospitals.
  • Overutilization leads to unnecessary radiation exposure, increased malignancy risk, and elevated healthcare costs.
  • Standardized imaging protocols and clinical decision tools are recommended to optimize pediatric trauma imaging.
Abstract

Keywords:
Computed tomographyImaging utilizationSpinal trauma

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