Implementation of a pediatric trauma cervical spine clearance pathway
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In brief
In brief
Implementation of a standardized cervical spine clearance pathway in pediatric trauma reduced plain radiographs from 34% to 16% and increased clinical clearance from 44% to 62%, with no missed injuries. The protocol safely decreased radiation exposure and specialty consultations while maintaining detection of the rare cervical spine injuries in this population.
Written by the GCMD Library team from the article.
Abstract
Purpose
Pediatric cervical spine injuries are rare events. Missed injuries must be weighed against radiation exposure and excess resource utilization in a young population. A universal pediatric cervical spine clearance algorithm does not exist. The study objective is to determine if care improved after the implementation of a standardized cervical spine clearance pathway by evaluating imaging rates, length of stay, speciality consultation, and injury detection.
Methods
A multidisciplinary group reviewed relevant literature to develop an algorithm for cervical spine clearance in pediatric trauma patients. We reviewed patient charts 15 months before and after implementation. Categorical comparisons were tested with Chi-square. A p value less than 0.05 was considered statistically significant.
Results
The pre- and post-implementation groups were homogenous when comparing demographics, mechanism and severity of injury. Using the cervical spine clearance pathway, patients received fewer plain cervical spine radiographs (34% vs 16%), fewer spine speciality consults (28% vs 13%), and more patients were cleared clinically (44% vs 62%) (p < 0.05). There were 2 (1.7%) documented injuries in the pre-implementation group and 3 (3%) documented injuries in the post-implementation group. There were no missed injuries.
Conclusions
Use of a standardized pathway allows more patients’ cervical spines to be cleared clinically and better utilizes resources without compromising patient care.
Level of evidence
Level III.
Type of study
Care Management Study.