Implementation of a Pediatric Trauma Cervical Spine Clearance Pathway
Natalie C. Luehmann, MD1; Jennifer A. Cirino, MD1; Alexander M. DeMare, MD1; Jacquelyn M. Pastewski, MD1; Ammer Al-Hadidi, MD1; Nathan M. Novotny, MD2; Begum Akay, MD2
1Beaumont Health, Royal Oak, MI; 2Beaumont Children's, Royal Oak, MI
Background: Pediatric cervical spine (c-spine) injuries are rare events with potentially devastating consequences. Missed injuries must be weighed against unnecessary and potential hazardous radiation exposure in a young population at low risk for c-spine injury. An algorithm for c-spine evaluation can help balance these conflicting ideals. Although no universal standard algorithm exists for the pediatric population, several studies have shown such a pathway is effective and can safely reduce radiation exposure. The study objective is to determine c-spine imaging rates before and after implementation of a standardized c-spine clearance pathway (CSCP).
Methods: A multi-disciplinary group reviewed relevant current literature to develop a novel algorithm for c-spine clearance in the pediatric trauma population. We reviewed patient charts 15 months before and 15 months after implementation. Statistical analysis was performed using Χ2 test, Fischer's exact test and Mann-Whitney U test. A p-value less than 0.05 was considered statistically significant.
Results: The pre-implementation (n=119) and post-implementation (n=109) groups were homogenous when comparing age, sex, mechanism of injury, and injury severity score. Results are summarized by the visual abstract.
Conclusions: Use of a standardized CSCP decreases unnecessary radiation exposure, allows more patients' c- spines to be cleared clinically, and better utilizes resources without compromising patient care. Our experience further supports the development and use of standardized pathways for evaluation of the pediatric cervical spine.
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