Imple me ntation of Pe diatr ic Ce r vic al Spine Cle ar anc e - - PowerPoint PPT Presentation

Shannon F. Rosati, MD

• D. Parrish, MD, R. Maarouf, MD, L. Wolfe, MS, M.

Poppe, BS, R. Manners, BS, K. Brown, BA, and J. Haynes, MD Imple me ntation of Pe diatr ic Ce r vic al Spine Cle ar anc e Guide line s at a Combine d T r auma Ce nte r : 12 Month Impac t

Nothing to Disclose

I ntro duc tio n

 Pe dia tric c e rvic a l spine injurie s a re fa r le ss

c o mmo n tha n a dult c e rvic a l spine injurie s

 T

he se injurie s o fte n diffe r fro m a dult injurie s

 De spite diffe re nc e s, c hildre n a re o fte n

sub je c te d to the sa me tra uma tic wo rk-up a s a dult pa tie nts

I ntro duc tio n

 Wo rk-up fo r c e rvic a l spine (c -spine ) injury

• fte n invo lve s a CT

sc a n in a dults

 A c -spine CT

e xpo se s c hildre n to ra dia tio n

 T

he re is a ne e d to c re a te se pa ra te c -spine c le a ra nc e g uide line s a t tra uma c e nte rs

Me tho ds

I

RB a ppro ve d, re tro spe c tive re vie w o f pe dia tric pa tie nts (a g e <15) pe rfo rme d 12 mo nths prio r to a nd 12 mo nths a fte r imple me nta tio n o f c e rvic a l spine c le a ra nc e g uide line s a t o ur c o mb ine d a dult a nd pe dia tric L e ve l I I nstitutio n

 Childre n we re b ro ug ht in a s e ithe r DE

L T A (hig he st tie r) o r E CHO (se c o nd tie r) tra uma te a m a le rts

Me tho ds

Da ta c o lle c te d inc lude d pa tie nt’ s a g e , I

SS, pre se nc e o f NE XUS c rite ria , ima g ing use d fo r c e rvic a l spine c le a ra nc e , a nd o the r CT sc a ns

• b ta ine d

Guide line s de ve lo pe d to e mpha size use o f

NE XUS c rite ria a nd to minimize ra dia tio n e xpo sure

Our I nstitutio na l Guide line s

NE XUS Cr ite r ia

1) Midline T e nde rne ss 2) Alte re d Co nsc io usne ss 3) I nto xic a tio n 4) Distra c ting I njury 5) Ne uro lo g ic De fic it

R ange of Motion Without Pain AP/ L ate r al Ce r vic al Spine F ilm Ce r vic al Spine Cle ar e d

AP/ L ate r al Ce r vic al Spine F ilm R e -e xamine CT C-spine Ce r vic al Spine Cle ar e d

No rma l Ab no rma l Ab no rma l

Ne ur

• sur

ge r y Consultation

No rma l No Pa in

On R e -e xamination: 1) Continue d Pain 2) Ne ur

• logic al De fic it

3) Pr

• longe d Intubation

MR I Ce r vic al Spine Ce r vic al Spine Cle ar e d

Ab no rma l

Ne ur

• sur

ge r y Consultation

No rma l

Re sults

Pr e -guide line s Post-guide line s

N=128 N=105 Ag e (me a n) 6.5 6.6 p=0.8 I SS (me a n) 7.4 5.7 p=0.2

Patie nt Char ac te r istic s

Re sults- Ne c k CT Sc a ns with a nd witho ut NE XUS

20 40 60 80 100 NE XUS YE S NE XUS NO

Pe r c e ntage of Patie nts who R e c e ive d Ne c k CT

Pre -Guide line s 20 40 60 80 100 NE XUS YE S NE XUS NO

Pe r c e ntage of Patie nts who R e c e ive d Ne c k CT

Po st-Guide line s N=46 N=9 N=24 N=6

Re sults- Ne c k CT Sc a ns with a ll o the r sc a ns

Pre -Guide line s

Patie nts R e c e iving Any Othe r CT sc an

NE CK CT YE S NE CK CT NO Po st-Guide line s

Patie nts R e c e iving Any Othe r CT sc an

Ne c k CT YE S Ne c k CT NO

Re sults- Ne c k CT Sc a ns with He a d CT

Pre -Guide line s Po st-Guide line s

Patie nts Re c e iving a CT He ad

CT Sc a n YE S CT Sc a n NO

Patie nts R e c e iving a CT He ad

Ne c k CT YE S Ne c k CT NO

Re sults

Guide line s C-spine CT Me an ISS

Pre - No 4.5 Ye s 11.3 Po st- No 4.6 Ye s 8.2

Patie nts Who R e c e ive d CT C-spine by ISS

Re sults

CT sc a ns de c re a se d b y 23% (p=.01) I ma g ing o the r tha n CT de c re a se d b y 13% (p=.02)

Re sults

CT sc a ns with he a d CT de c re a se d By 16% (p=.09) CT sc a ns with a ny o the r CT de c re a se d By 15% (p=.08)

Re sults

T

he re we re no misse d c e rvic a l spine injurie s

Co nc lusio n

 Guide line imple me nta tio n c a n ha ve a n imme dia te

impa c t o n de c re a sing pe dia tric c e rvic a l spine CT sc a n usa g e a nd sho uld impro ve o ve r time

 T

he c re a tio n o f se pa ra te g uide line s fo r c le a ra nc e o f the c e rvic a l spine in a pe dia tric po pula tio n c o uld b e utilize d a t o the r ma jo r c o mb ine d tra uma c e nte rs

 Guide line s ma y ha ve a pplic a b ility in lo we r vo lume

no n-pe dia tric tra uma c e nte rs a s e xpe rie nc e de ve lo ps

Questions?