Factors associated with the use of cervical spine computed tomography imaging in pediatric trauma patients

  • Mannix R
  • Nigrovic L
  • Schutzman S
 et al. 
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Abstract

Objectives: The objectives were to identify patient and hospital
characteristics associated with the use of computed tomography (CT)
imaging of the cervical spine (c-spine) in the evaluation of injured
children and, in particular, to examine the influence of hospital
setting.
Methods: This was a retrospective cohort of children younger than 19
years of age from the Massachusetts Hospital Emergency Department (ED)
database who were discharged from the ED with an injury diagnosis from
2005 through 2009. Multivariable logistic regression was used to analyze
characteristics associated with CT imaging of the c-spine.
Results: Of the 929,626 pediatric patients diagnosed with an injury in
Massachusetts EDs and then discharged home, 1.3% underwent CT imaging
of the c-spine. Rates of CT imaging nearly doubled over the 5 years. In
the multivariable model, patient age (adjusted odds ratio {[}AOR] = 2.3,
95% confidence interval {[}CI] = 2.0 to 2.7 for children age 12 to 18
years vs. under 1 year of age) and evaluation outside of a pediatric
Level I trauma center (AOR = 2.2, 95% CI = 1.1 to 4.3 for children
evaluated at non Level I trauma centers vs. pediatric Level I trauma
centers; AOR = 2.1, 95% CI = 0.93 to 4.7 for children evaluated at
adult Level I trauma centers vs. pediatric Level I trauma centers) were
associated with higher rates of CT imaging of the c-spine.
Conclusions: Cervical spine CT imaging for children discharged from the
ED with trauma diagnoses increased from 2005 through 2009. Older age and
evaluation outside a Level I pediatric trauma center were associated
with a higher c-spine CT rate. Educational interventions focused outside
pediatric trauma centers may be an effective approach to decreasing CT
imaging of the c-spine of pediatric trauma patients. ACADEMIC EMERGENCY
MEDICINE 2011; 18: 906-911 (C) 2011 by the Society for Academic
Emergency Medicine

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