儿童颈椎评估的标准化方案可减少影像学检查的应用：儿科颈椎间隙工作组方案的初步研究。

A Standardized Protocol for Cervical Spine Evaluation in Children Reduces Imaging Utilization: A Pilot Study of the Pediatric Cervical Spine Clearance Working Group Protocol.

机构信息

Department of Pediatric General, Thoracic, and Minimally Invasive Pediatric Surgery.

Drexel University College of Medicine, Philadelphia, PA.

出版信息

J Pediatr Orthop. 2020 Sep;40(8):e780-e784. doi: 10.1097/BPO.0000000000001619.

DOI:10.1097/BPO.0000000000001619

PMID:32604349

Abstract

BACKGROUND

Cervical spine injuries (CSI) have the potential to cause severe morbidity in children. Multiple imaging studies are used during evaluation of CSIs but come at a cost, both financially and in radiation exposure. To reduce resource utilization and radiation exposure, we implemented the Pediatric Cervical Spine Clearance Working Group (PCSCWG) standardized protocol (SP) for evaluating CSIs in children.

METHODS

Children below 18 years old presenting with concern for CSI at a level 1 pediatric trauma center were reviewed before (July 2015 to May 2016) and after (November 2017 to June 2018) protocol implementation. Demographics, injuries, and imaging utilization were extracted. The primary outcomes were the proportion of patients cleared with clinical exam, and the proportion undergoing x-ray, computed tomography, or magnetic resonance image. The secondary outcome was the estimated difference in imaging charges based on the annual reduction in radiographic studies.

RESULTS

During the study 359 children were evaluated for CSIs (248 pre-SP, 111 post-SP). Patients were similar with respect to age, injury severity score, and mechanism of injury. Protocol adherence was 87.4%. The prevalence of CSI was similar in the preprotocol and postprotocol cohorts (2.8% vs. 1.8%, P=0.567). Children treated after protocol implementation were significantly more likely to be cleared by clinical exam (15.3% vs. 43.2%, P<0.001). Significantly fewer children had x-rays (70.2% vs. 55.0%, P=0.005) and computed tomography scans (14.5% vs. 5.4%, P=0.013) in the postprotocol period. There was no difference in the utilization of magnetic resonance image (6.9% vs. 7.2%, P=0.904) or the proportion of children discharged with a cervical collar (10.1% vs. 12.6%, P=0.476). No patients in either group were found to have a previously undiagnosed injury at follow-up. The reduction in radiographic studies translates to an estimated annual reduction in imaging charges of $396,476.

CONCLUSIONS

The PCSCWG protocol for evaluating CSIs reduced the number of radiographic studies performed and estimated imaging charges while reliably identifying CSIs.

摘要

背景

颈椎损伤（CSI）有可能导致儿童严重发病。在评估 CSI 时会使用多种影像学检查，但这些检查既花费金钱，又有辐射暴露的风险。为了减少资源利用和辐射暴露，我们实施了小儿颈椎间隙工作组（PCSCWG）的 CSI 评估标准化方案（SP）。

方法

在 1 级儿科创伤中心，对年龄在 18 岁以下、疑似 CSI 的儿童进行回顾性分析，研究时间为方案实施前（2015 年 7 月至 2016 年 5 月）和实施后（2017 年 11 月至 2018 年 6 月）。提取患者的人口统计学、损伤和影像学利用情况。主要结局为通过临床检查排除 CSI 的患者比例，以及进行 X 射线、计算机断层扫描或磁共振成像的患者比例。次要结局为根据放射学研究的年度减少估计影像学费用的差异。

结果

研究期间共评估了 359 例 CSI 患儿（248 例为 SP 前，111 例为 SP 后）。患者的年龄、损伤严重程度评分和损伤机制相似。方案的依从性为 87.4%。在方案前和方案后组中，CSI 的患病率相似（2.8%对 1.8%，P=0.567）。在实施方案后治疗的患儿通过临床检查排除 CSI 的可能性明显更高（15.3%对 43.2%，P<0.001）。在方案后组中，进行 X 射线检查的患儿比例明显较低（70.2%对 55.0%，P=0.005）和计算机断层扫描检查（14.5%对 5.4%，P=0.013）。磁共振成像的利用率无差异（6.9%对 7.2%，P=0.904）或有颈椎领带出院的患儿比例（10.1%对 12.6%，P=0.476）。两组均无患者在随访中发现先前未诊断的损伤。放射学检查的减少预计每年可减少 396,476 美元的影像学费用。