Implementation of a dual cervical spine and blunt cerebrovascular injury assessment pathway for pediatric trauma patients

Llach, Maria Schonenberg; Fishe, Jennifer N.; Yorkgitis, Brian K.

doi:10.1016/j.ajem.2021.03.024

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…There were no missed CSIs or delays in their diagnosis in children younger than 8 years at our institution after the CSI screening guideline was implemented. This is consistent with the findings after similar pediatric CSI screening tools were implemented at other institutions 18–20 . The majority of these screening tools included CT from the occiput to T1 in their algorithm, although 1 study reported screening using CT from the occiput to C2 in conscious patients younger than 8 years 19 .…”

Section: Discussionsupporting

confidence: 81%

“…the findings after similar pediatric CSI screening tools were implemented at other institutions. [18][19][20] The majority of these screening tools included CT from the occiput to T1 in their algorithm, although 1 study reported screening using CT from the occiput to C2 in conscious patients younger than 8 years. 19 We found a CSI rate of 1.5% which is consistent with most published literature.…”

Section: Discussionmentioning

confidence: 99%

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A Pediatric Cervical Spine Clearance Guideline Leads to Fewer Unnecessary Computed Tomography Scans and Decreased Radiation Exposure

Douglas¹,

McNickle²,

Jones³

et al. 2022

Pediatr Emer Care

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ObjectivesPhysical examination and computed tomography (CT) are useful to rule out cervical spine injury (CSI). Computed tomography scans increase lifetime cancer risk in children from radiation exposure. Most CSI in children occur between the occiput and C4. We developed a cervical spine (C-spine) clearance guideline to reduce unnecessary CTs and radiation exposure in pediatric trauma patients.MethodsA pediatric C-spine clearance guideline was implemented in September 2018 at our Level 2 Pediatric Trauma Center. Guidance included CT of C1 to C4 to scan only high-yield regions versus the entire C-spine and decrease radiation dose. A retrospective cohort study was conducted comparing preguideline and postguideline of all pediatric trauma patients younger than 8 years screened for CSI from July 2017 to December 2020. Primary endpoints included the following: number of full C-spine and C1 to C4 CT scans and radiation dose. Secondary endpoints were CSI rate and missed CSI. Results were compared using χ2 and Wilcoxon rank-sum test with P < 0.05 significant.ResultsThe review identified 726 patients: 273 preguideline and 453 postguideline. A similar rate of total C-spine CTs were done in both groups (23.1% vs 23.4%, P = 0.92). Full C-spine CTs were more common preguideline (22.7% vs 11.9%, P < 0.001), whereas C1 to C4 CT scans were more common post-guideline (11.5% vs 0.4%, P < 0.001). Magnetic resonance imaging utilization and CSIs identified were similar in both groups. The average radiation dose was lower postguideline (114 vs 265 mGy·cm−1; P < 0.001). There were no missed CSI.ConclusionsA pediatric C-spine clearance guideline led to increasing CT of C1 to C4 over full C-spine imaging, reducing the radiation dose in children.Level of EvidenceLevel IV, therapeutic.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

A Pediatric Cervical Spine Clearance Guideline Leads to Fewer Unnecessary Computed Tomography Scans and Decreased Radiation Exposure

Douglas¹,

McNickle²,

Jones³

et al. 2022

Pediatr Emer Care

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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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Creating an evidence-based pathway for assessing and managing cervical spine and blunt cerebrovascular injury in pediatric trauma population

Sutherland

Selvakumar

McKenney

et al. 2021

The American Journal of Emergency Medicine

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Implementation of a dual cervical spine and blunt cerebrovascular injury assessment pathway for pediatric trauma patients

Cited by 3 publications

References 20 publications

A Pediatric Cervical Spine Clearance Guideline Leads to Fewer Unnecessary Computed Tomography Scans and Decreased Radiation Exposure

A Pediatric Cervical Spine Clearance Guideline Leads to Fewer Unnecessary Computed Tomography Scans and Decreased Radiation Exposure

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

Creating an evidence-based pathway for assessing and managing cervical spine and blunt cerebrovascular injury in pediatric trauma population

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