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

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 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

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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 o 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 o 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

nstitutio na l Guide line s Our I

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 AP/ L ate r al Ce r vic al Pain Spine F ilm Ce r vic al Spine Cle ar e d

AP/ L ate r al Ce r vic al Spine F ilm No rma l Ab no rma l R e -e xamine CT C-spine Ab no rma l No Pa in No rma l Ce r vic al Spine Cle ar e d Ne ur osur ge r y Consultation

On R e -e xamination: 1) Continue d Pain 2) Ne ur ologic al De fic it 3) Pr olonge d Intubation MR I Ce r vic al Spine Ab no rma l No rma l Ce r vic al Spine Cle ar e d Ne ur osur ge r y Consultation

Re sults Patie nt Char ac te r istic s 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

Re sults- Ne c k CT Sc a ns with a nd witho ut NE XUS Pre -Guide line s Po st-Guide line s Pe r c e ntage of Patie nts who Pe r c e ntage of Patie nts who R e c e ive d Ne c k CT R e c e ive d Ne c k CT 100 100 N=46 80 80 N=24 60 60 N=9 N=6 40 40 20 20 0 0 NE XUS YE S NE XUS YE S NE XUS NO NE XUS NO

Re sults- Ne c k CT Sc a ns with a ll o the r sc a ns Pre -Guide line s Po st-Guide line s Patie nts R e c e iving Any Patie nts R e c e iving Any Othe r CT sc an Othe r CT sc an NE CK CT Ne c k CT YE S YE S NE CK CT Ne c k CT NO 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 R e c e iving a CT Patie nts Re c e iving a CT He ad He ad Ne c k CT CT Sc a n YE S YE S Ne c k CT CT Sc a n NO NO

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

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

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

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