Douglas Geoffrey P, McNickle Allison G, Jones Stephanie A, Dugan Mark C, Kuhls Deborah A, Fraser Douglas R, Chestovich Paul J
From the UNLV School of Medicine.
Pediatr Emerg Care. 2023 May 1;39(5):318-323. doi: 10.1097/PEC.0000000000002867. Epub 2022 Nov 30.
Physical examination and computed tomography (CT) are useful to rule out cervical spine injury (CSI). Computed tomography scans increase lifetime cancer risk in children from radiation exposure. Most CSI in children occur between the occiput and C4. We developed a cervical spine (C-spine) clearance guideline to reduce unnecessary CTs and radiation exposure in pediatric trauma patients.
A pediatric C-spine clearance guideline was implemented in September 2018 at our Level 2 Pediatric Trauma Center. Guidance included CT of C1 to C4 to scan only high-yield regions versus the entire C-spine and decrease radiation dose. A retrospective cohort study was conducted comparing preguideline and postguideline of all pediatric trauma patients younger than 8 years screened for CSI from July 2017 to December 2020. Primary endpoints included the following: number of full C-spine and C1 to C4 CT scans and radiation dose. Secondary endpoints were CSI rate and missed CSI. Results were compared using χ 2 and Wilcoxon rank-sum test with P < 0.05 significant.
The review identified 726 patients: 273 preguideline and 453 postguideline. A similar rate of total C-spine CTs were done in both groups (23.1% vs 23.4%, P = 0.92). Full C-spine CTs were more common preguideline (22.7% vs 11.9%, P < 0.001), whereas C1 to C4 CT scans were more common post-guideline (11.5% vs 0.4%, P < 0.001). Magnetic resonance imaging utilization and CSIs identified were similar in both groups. The average radiation dose was lower postguideline (114 vs 265 mGy·cm -1 ; P < 0.001). There were no missed CSI.
A pediatric C-spine clearance guideline led to increasing CT of C1 to C4 over full C-spine imaging, reducing the radiation dose in children.
Level IV, therapeutic.
体格检查和计算机断层扫描（CT）有助于排除颈椎损伤（CSI）。CT扫描会因辐射暴露增加儿童患癌终生风险。儿童的大多数CSI发生在枕骨和C4之间。我们制定了一项颈椎（C脊柱）清除指南，以减少儿科创伤患者不必要的CT检查和辐射暴露。
2018年9月，我们的二级儿科创伤中心实施了儿科C脊柱清除指南。指南包括对C1至C4进行CT扫描时，仅扫描高风险区域而非整个C脊柱，以降低辐射剂量。对2017年7月至2020年12月期间所有接受CSI筛查的8岁以下儿科创伤患者进行了一项回顾性队列研究，比较指南实施前和实施后的情况。主要终点包括：全C脊柱和C1至C4 CT扫描的数量及辐射剂量。次要终点为CSI发生率和漏诊的CSI。使用χ²检验和Wilcoxon秩和检验比较结果，P<0.05为有统计学意义。
该综述共纳入726例患者：指南实施前273例，指南实施后453例。两组全C脊柱CT检查的比例相似（23.1%对23.4%，P=0.92）。指南实施前全C脊柱CT检查更为常见（22.7%对11.9%，P<0.001），而指南实施后C1至C4 CT扫描更为常见（11.5%对0.4%，P<0.001）。两组的磁共振成像使用率和确诊的CSI相似。指南实施后的平均辐射剂量较低（114对265 mGy·cm⁻¹；P<0.001）。没有漏诊的CSI。
儿科C脊柱清除指南使C1至C4的CT检查相较于全C脊柱成像有所增加，降低了儿童的辐射剂量。
四级，治疗性。
