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Preliminary Results Using a Reduced Radiation Cervical Spine Clearance Algorithm in Pediatric Trauma Patients: A Simplified Approach
Matthew Moront, MD, Martin Herman, MD and Christine Campbell, RN, St. Christopher's Hospital for Children, Philadelphia PA

Abstract:
Background: Cervical spine clearance protocols differ from one institution to another. No clear consensus has been reached among institutions because limited evidence-based literature exists to guide development of these protocols, particularly for pediatric patients Methods: The trauma database was reviewed from 2011-2014 to identify the patients that required cervical spine clearance. The patients were then compared pre-algorithm and post-algorithm. Data analysis was performed to determine the number of patients undergoing CT cervical spine, ordering service and missed injuries. Results: In 2011 the institution had 949 trauma contacts of which 107 CT cervical spines were performed. It was recognized that there was no consistency among providers on which patients should have a CT cervical spine. In 2012 a multidisciplinary team was assembled to review our current practice and current literature. This team devised a simplified approach to clearing the cervical spine effective September 2012. All patients were reviewed for cervical spine clearance and adherence to the protocol. This robust PI and simplified algorithm decreased CT cervical spine from 11% (107 out of 949) in 2011 and 15% (144 out of 941) in 2012 to 7% (67 out of 948) in 2013 and 5.9% (47 out of 793) in 2014. Conclusion: The results reflected that the safety, efficacy, and patient outcomes of our cervical spine clearance algorithm has decreased radiation exposure with no missed injuries. Utilizing a simplified approach is can be easily replicated at other institutions in order to reduce radiation exposure to pediatric patients.
Figures:

Objective:
At the end of this activity, the learner will be able to evaluate the safety, efficacy, and patient outcomes of a cervical spine clearance algorithm.Objective Content:
Review results over three years utilizing a simplified algorithm to clear a pediatric patient's cervical spine


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