From the Keck School of Medicine (E.E.R.), Division of Pediatric Surgery, Department of Surgery (S.O., R.G.S.), and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Trauma Acute Care Surg. 2024 Sep 1;97(3):400-406. doi: 10.1097/TA.0000000000004242. Epub 2024 Jan 10.
Cervical spine (c-spine) evaluation is a critical component in trauma evaluation, and although several pediatric c-spine evaluation algorithms have been developed, none have been widely implemented. Here, we assess rates of c-spine imaging use across children's hospitals, specifically temporal trends in imaging use, variation across hospitals in imaging used, and timing of magnetic resonance imaging in admitted patients.
Data from the Children's Hospital Associations Pediatric Health Information System were abstracted from 2015 to 2020. Patients younger than 18 years seen in the emergency department with an International Classification of Diseases, Tenth Revision , code indicative of trauma and c-spine plain radiograph or computed tomography (CT) in the emergency department were included. Data visualization and descriptive statistics were used to assess rates of imaging use by age, year, hospital, injury severity, and day of service. Changes in rates of imaging use over time were evaluated via simple linear regression.
Across 25,238 patient encounters at 35 children's hospitals, there was an increase in use of c-spine CT from 2015 to 2020 (28.5-36.5%). There was substantial interinstitutional variation in rates of use of plain radiographs versus CT for initial evaluation of the c-spine across all age groups. Magnetic resonance imaging was obtained more than 3 days after admission in 31.5% of intensive care patients who received this imaging.
Increasing use of CT, substantial interinstitutional variation in rates of use of plain radiographs versus CT, and heterogenous timing of magnetic resonance imaging for evaluation of the pediatric c-spine demonstrate the growing need for development and implementation of an age-specific c-spine evaluation algorithm to guide judicious use of diagnostic resources.
Prognostic and Epidemiological; Level III.
颈椎（c-spine）评估是创伤评估的关键组成部分，尽管已经开发了几种儿科 c-spine 评估算法，但没有一种得到广泛实施。在这里，我们评估了儿童医院的 c-spine 成像使用率，特别是成像使用率的时间趋势、不同医院使用的成像方式的差异以及住院患者磁共振成像的时间。
从 2015 年至 2020 年，从儿童健康协会儿科健康信息系统中提取数据。在急诊科就诊的年龄小于 18 岁的患者，国际疾病分类，第十版有创伤和颈椎平片或 CT 的代码，并在急诊科进行了检查。使用数据可视化和描述性统计来评估按年龄、年份、医院、损伤严重程度和服务日计算的成像使用率。通过简单线性回归评估随时间变化的成像使用率变化。
在 35 家儿童医院的 25238 例患者就诊中，颈椎 CT 的使用率从 2015 年到 2020 年有所增加（28.5-36.5%）。在所有年龄段，初始评估颈椎时，与 CT 相比，平片的使用率在机构间存在很大差异。在接受磁共振成像的重症监护患者中，31.5%的患者在入院后超过 3 天获得了该成像。
CT 的使用增加、平片与 CT 的使用率存在实质性的机构间差异，以及磁共振成像评估儿科 c-spine 的时间不同，这表明需要制定和实施特定年龄的 c-spine 评估算法，以指导合理利用诊断资源。
预后和流行病学；III 级。
