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Objective
To evaluate trauma practitioners’ utilization and perceptions of imaging and guidelines for clearing the pediatric cervical spine.
Design
Paper survey conducted February-March 2013.
Setting
A rural level one trauma center.
Participants
We surveyed a convenience sample of residents and staff physicians in the emergency medicine and surgical departments who care for pediatric trauma patients (n=45, response rate 56%).
Main Outcome Measures
Physicians’ perceptions of their clinical and institutional practice in regards to choice of imaging, concern for radiation exposure, and use of cervical spine clearance guidelines.
Results
The majority of physicians (75%) utilize guidelines when evaluating the cervical spine in injured children and regularly apply adult guidelines in these patients (NEXUS 88%, adult Canadian C-Spine Rule 58%). Nearly all (96%) would be interested in using a validated pediatric guideline if it existed. Most expressed they were “concerned” (50%) or “very concerned” (33%) about radiation exposure in children from diagnostic imaging. When presented with clinical scenarios with increasing likelihood of requiring imaging, almost all (96%) cleared the spine of a low risk patient with no imaging. However, physicians often ordered CT when asked to evaluate the moderate (33%) and high (75%) risk patients. When asked about the Trauma Association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway Consensus Guidelines, only 8% reported using the guideline in their practice, compared with 88% and 58% for well-known adult guidelines (NEXUS and adult Canadian C-Spine Rule).
Conclusions
The application of adult guidelines in children likely results in many unnecessary CT scans. Concern for radiation exposure exists, but CT continues to be routinely used. Awareness and utilization of published pediatric cervical spine clearance guidelines is limited.