Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience

Slaar, Annelie; Fockens, M. Matthijs; Rijn, Rick R. van; Maas, Mario; Goslings, J. Carel; Bakx, Roel; Streekstra, Geert J.; Beenen, Ludo F. M.; Schep, N.W.L.

doi:10.1016/j.ejrad.2015.11.005

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…These data correspond with the findings of previous studies-performed both in level 1 trauma centres and other hospitals-which have also reported low incidences. The incidence varies from 0.3-3.7%, depending on the specific population studied [4][5][6][7]28]. Our study confirms that a child presenting at a level 2 trauma centre after blunt trauma is very unlikely to have relevant C-spine injury.…”

Section: Discussionsupporting

confidence: 69%

“…With regard to the indication for imaging, adherence to our initial and updated in-hospital protocol was high. A study by Slaar et al in a level 1 trauma centre also found that Dutch physicians generally do adhere to the guidelines in terms of which children require imaging [4]. Nevertheless, radiologic imaging could have been avoided in at least ten percent of our patients if the protocols had been followed in all cases.…”

Section: Discussionmentioning

confidence: 73%

“…Paediatric patients suffering blunt trauma are always assessed for cervical spine injury (CSI) given the potential risk of morbidity and mortality [1][2][3]. However, CSI is rare, accounting for less than 2% of all children being evaluated after blunt trauma, even in higher risk populations presenting at level 1 trauma centres [4][5][6][7]. Identifying children at risk of CSI is challenging, since physical examination can be unreliable [8].…”

Section: Introductionmentioning

confidence: 99%

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Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. Methods We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. Results We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. Conclusion Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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“…Traditionally, it has been thought that there is a lack of adherence to medical imaging referral guidelines by referrers 22 . However, there is specific evidence that paediatric trauma medical imaging guidelines in the ED can have excellent compliance rates 19,28 . McGrew and colleagues have clearly shown that in a level II paediatric trauma centre, the implementation of evidence based CT guidelines for paediatric trauma reduced CT rates by 16% without a difference in outcome 29 …”

Section: Discussionmentioning

confidence: 99%

Paediatric trauma imaging in a regional Queensland hospital: Do we need clearer guidance?

Lynham¹,

Boxall

Warren

et al. 2022

Emerg Medicine Australasia

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Objective Paediatric trauma is a major cause of morbidity and mortality in those aged 0–14. Anatomical and physiological differences require a specialised approach to paediatric trauma care. Medical imaging, particularly computed tomography (CT) scans, requires specific consideration because of the consequences of radiation exposure in the paediatric population. The present study compares current practice of CT scan ordering in paediatric trauma patients at a regional Australian hospital against consensus guidelines published in the UK. Methods A retrospective audit of paediatric trauma CT scans referred from the ED from May 2017 to May 2018 was completed. Details relating to CT scan ordering were reviewed and compliance with the Royal College of Radiologists Paediatric trauma protocols, was determined. Descriptive statistics and χ2 tests comparing those that met and did not meet guidelines were performed. Results A total of 71 CT scans were included with an overall compliance rate of 56.3%. Specific regional compliance was lowest with CT neck at 14%. Patients where a trauma call was initiated were more likely to receive a full body (pan) scan rather than region specific imaging. Compliance improved when paediatric team involvement was documented. Conclusions Evidence‐based guidelines for CT imaging in paediatric trauma are essential to reduce unnecessary radiation exposure for children. The present study has demonstrated that current practice has the potential to be improved and that decisions should involve a multidisciplinary team.

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Triage tools for detecting cervical spine injury in paediatric trauma patients

Tavender,

Eapen,

Wang

et al. 2024

Cochrane Database of Systematic Reviews

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Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience

Abstract: The adherence to the international guidelines when to obtain radiographic imaging was 100%. However, in a large proportion of patients (56%), not the recommended number of radiographs was obtained.

Cited by 5 publications

References 21 publications

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Paediatric trauma imaging in a regional Queensland hospital: Do we need clearer guidance?

Triage tools for detecting cervical spine injury in paediatric trauma patients

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