Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized?

Sharma, Bharath; Kolousek, Anastasia; Lian, Brad; Koganti, Deepika; Smith, Randi N.; Sola, Richard

doi:10.1016/j.jss.2022.09.016

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Pediatric patients, particularly infants and young children, are more sensitive to radiation exposure compared to adults. Their increased radiosensitivity stems from their developing bodies, higher metabolic rates, and longer life expectancies, which provide more time for potential radiation-related effects to manifest [ 6 , 25 , 50 ]. Therefore, guidelines for pediatric CT imaging generally aim to minimize unnecessary radiation exposure [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Hassankhani,

Valizadeh,

Amoukhteh

et al. 2023

Emerg Radiol

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Pediatric blunt trauma is a major cause of morbidity and mortality, and computed tomography (CT) imaging is vital for accurate evaluation and management. Pediatric trauma centers (PTCs) have selective CT practices, while non-PTCs may differ, resulting in potential variations in CT utilization. The objective of this study is to delineate disparities in CT utilization for pediatric blunt trauma patients between PTCs and non-PTCs. A systematic review and meta-analysis were conducted following established guidelines, searching PubMed, Scopus, and Web of Science up to March 3, 2023. All studies examining CT utilization in the management of pediatric (aged < 21 years) blunt trauma and specifying the type of trauma center(s) were included, and data were extracted and analyzed using STATA software version 17.0. An analysis of 30 studies revealed significant variations in CT scan utilization among pediatric blunt trauma patients across different types of trauma centers. PTCs exhibited lower pooled rates of abdominopelvic CT scans (35.4% vs. 44.9%, p < 0.01), cranial CT scans (36.9% vs. 42.9%, p < 0.01), chest CT scans (14.5% vs. 25.4%, p < 0.01), and cervical spine CT scans (23% vs. 45%, p < 0.01) compared to adult or mixed trauma centers (ATCs/MTCs). PTCs had a pooled rate of 54% for receiving at least one CT scan, while ATCs/MTCs had a higher rate of 69.3% (p < 0.05). The studies demonstrated considerable heterogeneity. These findings underscore the need to conduct further research to understand the reasons for the observed variations and to promote appropriate imaging usage, minimize radiation exposure, and encourage collaboration between pediatric and adult trauma centers.

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Section: Discussionmentioning

confidence: 99%

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Hassankhani,

Valizadeh,

Amoukhteh

et al. 2023

Emerg Radiol

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Triage tools for detecting cervical spine injury in paediatric trauma patients

Tavender,

Eapen,

Wang

et al. 2024

Cochrane Database of Systematic Reviews

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Trends and variation in cervical spine imaging utilization across children's hospitals for pediatric trauma

Ross,

Ourshalimian,

Spurrier

et al. 2024

J Trauma Acute Care Surg

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Background Cervical spine evaluation is a critical component in trauma evaluation, and though several pediatric cervical spine evaluation algorithms have been developed, none has been widely implemented. Here, we assess rates of cervical 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 was abstracted from 2015 to 2020. Patients less than 18 years of age seen in the emergency department with an International Classification of Diseases (ICD)-10 code indicative of trauma and cervical spine plain radiograph or computed tomography 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 Chi-square test. Results Across 25,238 patient encounters at 35 children’s hospitals, there was an increase in use of cervical spine computed tomography from 2015 to 2020 (28.5 to 36.5%). There was substantial inter-institutional variation in rates of use of plain radiographs versus computed tomography for initial evaluation of the cervical spine across all age groups and regardless of rates of severe injury across institutions. Magnetic resonance imaging was obtained more than three days after admission in 31.5% of intensive care patients who received this imaging. Conclusions Increasing use of computed tomography, substantial inter-institutional variation in rates of use of plain radiographs versus computed tomography, and heterogenous timing of magnetic resonance imaging for evaluation of the pediatric cervical spine demonstrate the growing need for development and implementation of an age-specific cervical spine evaluation algorithm to guide judicious use of diagnostic resources. Level of Evidence Level III, Epidemiologic

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Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized?

Cited by 3 publications

References 21 publications

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Triage tools for detecting cervical spine injury in paediatric trauma patients

Trends and variation in cervical spine imaging utilization across children's hospitals for pediatric trauma

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