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Institutional Variation in Cervical Spine Imaging among Children with Blunt Trauma: A Multicenter Prospective
Pradip P Chaudhari1, Alexander Rogers2, Rebecca K Burger3
1Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Objective:
To describe institutional variation in use of cervical spine radiographs (x-ray) and computed tomography (CT) among children evaluated following blunt trauma.
Study Design:
We conducted a planned secondary analysis of a multicenter, observational cohort study of children 0-17 years old evaluated for possible cervical spine injury (CSI) in 18 emergency departments (EDs) from December 2018-October 2021. Our primary outcome was any ED cervical spine x-ray or CT, and our secondary outcome was use of CT only. We performed univariable logistic regression, reporting ED-level unadjusted and injury severity-adjusted proportions of children with any cervical spine imaging and CT only, stratified by presenting ED type (referring general ED vs pediatric ED). Severity adjustment was based on Pediatric Emergency Care Applied Research Network high-risk predictors (Glasgow Coma Scale 3-8, unresponsiveness, abnormal airway/breathing/circulation, and focal neurologic deficits).
Results:
We enrolled 22 430 eligible children, of whom 17.9% (n = 4008) were referred from a general ED. Cervical spine x-ray or CT was performed in 52.9% (n = 11 865) and 1.9% (n = 433) were diagnosed with a CSI. After adjusting for severity, imaging proportions were similar within each ED type (referring general EDs and pediatric EDs). Among children whose initial evaluation occurred in a referring general ED, 71.3% underwent any cervical spine imaging and 32.3% underwent CT as the sole modality. Among children presenting directly to a pediatric ED, the corresponding proportions were 48.9% and 7.9%.
Conclusions:
In this observational study of children with potential CSI, those managed in referring general EDs and transferred to pediatric EDs more frequently underwent cervical spine imaging, including CT as the sole modality, than those presenting directly to pediatric EDs. These data can inform future benchmarking to assess concordance after implementation of the PECARN CSI decision rule.
