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PIPS Guided Quality Improvement Filters Can Significantly Reduce CT Imaging in Pediatric Trauma Patients
Christopher R. Connelly, MD, Jennifer M. Watters, MD, Pamela Bilyeu, MN, RN, Lynn S. Eastes, RN, MS, ACNP-BC, and Mubeen A. Jafri, MD, Oregon Health & Science University, Portland OR

Abstract: Background Morbidity and mortality of cervical spine injury in pediatric trauma patients is high, necessitating quick and accurate diagnosis. Best practices emphasize minimizing radiation exposure through decreased reliance on computed tomography (CT), instead using physical examination and alternate imaging techniques. We implemented an institutional performance improvement and patient safety program (PIPS) initiative for cervical spine clearance in 2010 due to high rates of CT scans in these patients (Figure). Methods Retrospective review of pediatric trauma patients before and after PIPS implementation was conducted. Rates of overall CT, spine CT, patient characteristics and injury severity were compared, and compliance with PIPS protocol was reviewed. P < 0.05 was defined as significant Results Injury severity was similar before and after implementation. Spine CT rates decreased significantly from 25% in 2009–2010, to 15% in the second half of 2014 (p=0.02). In 2007, nearly 71% of pediatric trauma patients received a CT scan for any reason. However, overall CT rate significantly decreased comparing 2009–2010 to 2013-2014 (53% v 39%, p<0.01). Current compliance with the protocol is excellent (90%) in 2014. Conclusions PIPS generated filters and protocols can significantly decrease the use of ionizing radiation. We demonstrate that a simple protocol focused on cervical spine imaging has high compliance, and decreased spine CT scans. A secondary benefit was a reduction in total CT imaging in pediatric trauma patients.

Figures:
PIPS Guided Quality Improvement Filters Can Significantly Reduce CT Imaging in Pediatric Trauma Patients

Objective: Describe best practices for workup and clearance of cervical spine injury in pediatric trauma patients.

Objective Content: Current best practices emphasize reducing use of CT scans to minimize ionizing radiation. Institutional protocols can help achieve these goals.


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