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.
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The authors thank Dr. Anthony Stallion and Dr. Michael Klein for their review of the final and revised manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institutional Review Board, approval #2017-258) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Our study used retrospective and prospective data available in the electronic medical record. The written authorization permitting disclosure of protected health information for research purposes, previously obtained from each patient, was utilized as consent for our use of these data. The authorization permits the use of patient medical record information, obtained in the normal course of patient care, for research purposes, such as this study, in the future. There was no direct contact with patients during the study. All patient data were de-identified following extraction from medical records, and subsequent import into a secure database, to ensure patient confidentiality.
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Luehmann, N.C., Pastewski, J.M., Cirino, J.A. et al. Implementation of a pediatric trauma cervical spine clearance pathway. Pediatr Surg Int 36, 93–101 (2020). https://doi.org/10.1007/s00383-019-04544-8
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DOI: https://doi.org/10.1007/s00383-019-04544-8