University of Minnesota Masonic Children's Hospital MINNEAPOLIS, Minnesota, United States
Background: The incidence of pediatric cervical spine injuries is estimated to be 1.5%.1 Although rare, the clinical implications can be severe for children and their families. The evaluation and workup of these injuries varies in general emergency departments (EDs), where pediatric specialists are often limited.
Clinical examination and plain radiographs can detect many spinal cord injuries. CT scans should not be routinely performed for initial evaluation of pediatric spinal trauma. In practice, CT scans are widely performed in the ED setting when imaging needs to be obtained expeditiously. Ionizing radiation is not without risks. Children are particularly radiosensitive and radiation exposure increases the risk of malignancy. In particular, cervical spine CT scans may carry an increased risk of thyroid cancer.2
We are initiating a quality improvement study within four EDs within our medical system as a first step towards understanding and changing the culture of performing c-spine CT scans. Objective: We collaborated with four general community emergency departments in a quality improvement project aimed at reducing the utilization of unnecessary CT scans in working up neck injuries. Design/Methods: We collaborated with four community Level III trauma center emergency departments not staffed by in-house pediatric specialists in our healthcare system.
We used ICD-10 codes to capture children who underwent a neck CT for blunt trauma. Pre-intervention dates were 6/1/15 to 12/31/15 and post-intervention dates were 1/1/16 to 7/31/17. Data variables collected were age, types and results of imaging performed, exam findings, and disposition.
An electronic BPA (best practice alert) was implemented to “alert” when a C-spine CT scan is ordered. We also conducted on-site discussions and educational sessions with general ED providers.
Dichotomous data will be used to create control charts to demonstrate, over time, the trend in CT scan rates.
We anticipate results being finalized by April 2024. The study was reviewed and approved by the study site Institutional Review Board (IRB).
