Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep;18(9):905-11.
doi: 10.1111/j.1553-2712.2011.01154.x. Epub 2011 Aug 19.

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

Rebekah Mannix  1 , Lise E Nigrovic, Sara A Schutzman, Kara Hennelly, Florence T Bourgeois, William P Meehan, Gary Fleisher, Michael Monuteaux, Lois K Lee
Affiliations

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

Rebekah Mannix et al. Acad Emerg Med. 2011 Sep.

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.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no disclosures or conflicts of interest to report.

Figures

Figure 1
Figure 1. Unadjusted Rates of Cervical Spine CT by Year and Hospital Type
Figure 2
Figure 2. Unadjusted Rates of Cervical Spine CT by Age and Pediatric Level 1 Trauma Center Status
See this image and copyright information in PMC

References

    1. Dietrich AM, Ginn-Pease ME, Bartkowski HM, King DR. Pediatric cervical spine fractures: predominantly subtle presentation. J Pediatr Surg. 1991;26(8):995–9. - PubMed
    1. Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR. A prospective multicenter study of cervical spine injury in children. Pediatrics. 2001;108(2):E20. - PubMed
    1. Como JJ, Diaz JJ, Dunham CM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma. 2009;67(3):651–9. - PubMed
    1. McCulloch PT, France J, Jones DL, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma. J Bone Joint Surg Am. 2005;87(11):2388–94. - PubMed
    1. Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S. Cervical spine clearance in blunt trauma: evaluation of a computed tomography-based protocol. J Trauma. 2005;59(1):179–83. - PubMed

Publication types

MeSH terms