Implementation of a pediatric trauma cervical spine clearance pathway.
Pediatric surgery international
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.
Luehmann NC, Pastewski JM, Cirino JA, Al-Hadidi A, DeMare AM, Riggs TW, Novotny NM, Akay B. Implementation of a pediatric trauma cervical spine clearance pathway. Pediatr Surg Int. 2020 Jan;36(1):93-101. doi: 10.1007/s00383-019-04544-8. Epub 2019 Aug 21. PMID: 31435734.