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Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized?

Published:October 21, 2022DOI:https://doi.org/10.1016/j.jss.2022.09.016

      Highlights

      • 61.7% of adolescent blunt trauma patients received CSCT, while only 8.3% had a positive finding on CSCT.
      • All patients with a positive CSCT failed NEXUS criteria.
      • 39% of patients with a negative CSCT met NEXUS criteria indicating a low risk of cervical spine injury.
      • This ATC had a low rate of positive findings on CSCT indicating CSCT was overutilized at the trauma center.
      • Use of NEXUS criteria as a screening tool for adolescent blunt trauma patients has the potential to reduce unnecessary CSCT by almost 40%.

      Abstract

      Introduction

      Cervical spine computed tomography (CSCT) scans are used to evaluate cervical spine traumatic injuries; however, recent evidence demonstrates that adult trauma centers (ATCs) overutilize CSCT when evaluating adolescent patients. This leads to unnecessary radiation exposure. The aim of this study is to review a level 1 ATC's use of CSCT in the adolescent blunt trauma population.

      Methods

      A retrospective chart review was conducted of a level 1 ATC's trauma database. Blunt trauma patients between the ages of 11 and 18 who receive a CSCT between January 2015 to December 2019 were included. The primary outcome was the prevalence of positive findings on CSCT scans. Data were analyzed using Fischer-Exact analysis and multivariate logistic regression where appropriate.

      Results

      Three-hundred thirty-seven of 546 (61.7%) adolescent blunt trauma patients received CSCT. Of those, 68.2% (230) were male; the mean age was 16.6 ± 1.0 y old. Twenty-eight patients (8.3%) had a positive finding on CSCT. All patients with a positive CSCT failed the National Emergency X-Radiography Utilization study (NEXUS) criteria while 123 patients (36.5%) with a negative CSCT met NEXUS criteria.

      Conclusions

      CSCT was overutilized in our trauma center. There is a low positive CSCT scan rate among adolescent patients, which aligns with the current literature. All patients with positive CSCT passed NEXUS criteria suggesting that a quality improvement project focusing on the use of the NEXUS criteria to assess the risk of cervical spine injury could potentially reduce the use of CSCT scans by nearly 40%.

      Keywords

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