TY - JOUR
T1 - A pediatric cervical spine clearance protocol to reduce radiation exposure in children
AU - Sun, Raphael
AU - Skeete, Dionne
AU - Wetjen, Kristel
AU - Lilienthal, Michele
AU - Liao, Junlin
AU - Madsen, Mark
AU - Lancaster, Gabriel
AU - Shilyansky, Joel
AU - Choi, Kent
PY - 2013/7
Y1 - 2013/7
N2 - Background: To minimize radiation exposure in children and reduce resource use, we implemented an age-specific algorithm to evaluate cervical spine injuries at a Level 1 trauma center. The effects of protocol implementation on computed tomography (CT) use in children (≤ 10 y) were determined. Methods: With institutional review board approval, we conducted a retrospective review using the institutional trauma registry. All pediatric patients (≤ 10 y) (n = 324) between January 2007 and present were reviewed. We excluded cases in which no imaging or outside imaging was performed. Patients were evaluated by physical exam alone, with the aid of plain radiograms or with cervical spine CT. All patients who required head CT also had CT of cervical spine to C3. We analyzed demographic, injury, and outcome data using STATA to perform chi-square and t-test, and to determine P value. P < 0.05 was defined as significant. We used the WinDose program to calculate the radiation-effective dose used in cervical spine CT. Results: There were 123 and 124 patients in the pre-protocol and post-protocol groups, respectively. Demographics, GCS, and injury analysis, specifically head-neck and face Injury Severity Scores showed no significant difference between groups. There was a 60% (P < 0.001) decrease in the use of full CTs after protocol implementation. We estimated that the protocol reduced the exposed area by 50% and decreased the radiation dose to the thyroid by > 80%. We extrapolated the combined effect results in a threefold reduction in radiation exposure. Conclusions: Implementation of a cervical spine protocol led to a significant reduction in radiation exposure among children.
AB - Background: To minimize radiation exposure in children and reduce resource use, we implemented an age-specific algorithm to evaluate cervical spine injuries at a Level 1 trauma center. The effects of protocol implementation on computed tomography (CT) use in children (≤ 10 y) were determined. Methods: With institutional review board approval, we conducted a retrospective review using the institutional trauma registry. All pediatric patients (≤ 10 y) (n = 324) between January 2007 and present were reviewed. We excluded cases in which no imaging or outside imaging was performed. Patients were evaluated by physical exam alone, with the aid of plain radiograms or with cervical spine CT. All patients who required head CT also had CT of cervical spine to C3. We analyzed demographic, injury, and outcome data using STATA to perform chi-square and t-test, and to determine P value. P < 0.05 was defined as significant. We used the WinDose program to calculate the radiation-effective dose used in cervical spine CT. Results: There were 123 and 124 patients in the pre-protocol and post-protocol groups, respectively. Demographics, GCS, and injury analysis, specifically head-neck and face Injury Severity Scores showed no significant difference between groups. There was a 60% (P < 0.001) decrease in the use of full CTs after protocol implementation. We estimated that the protocol reduced the exposed area by 50% and decreased the radiation dose to the thyroid by > 80%. We extrapolated the combined effect results in a threefold reduction in radiation exposure. Conclusions: Implementation of a cervical spine protocol led to a significant reduction in radiation exposure among children.
KW - Cervical injury
KW - Cervical spine
KW - Cervical spine injury
KW - Cervical trauma
KW - Pediatric cervical spine
KW - Pediatric trauma
KW - Radiation exposure
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U2 - 10.1016/j.jss.2012.12.048
DO - 10.1016/j.jss.2012.12.048
M3 - Article
C2 - 23357274
AN - SCOPUS:84879083093
SN - 0022-4804
VL - 183
SP - 341
EP - 346
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -