![]() ![]() The pathway was implemented in August 2016 with institutional review board approval, and we began collecting data in September 2016. This process ensured that the evaluating trauma team’s use of the pathway was documented. Furthermore, the algorithm was strategically placed into our electronic health records by inserting the guidelines into our history and physical templates. It was also posted in the trauma bay for quick reference during trauma activations. This training was provided during educational conferences, and digital copies of the pathway were widely distributed. The four pediatric trauma surgeons educated the surgical and emergency medicine groups-including 36 general surgery residents, eight pediatric emergency physicians, and six pediatric emergency medicine fellows-about the pathway before its implementation, because these specialists are present during the initial trauma evaluation. Pediatric trauma c-spine Clearance guidelines Once all the specialty groups reached consensus, we presented the pathway to our hospital’s medical executive board for final approval (see Figures 1A and 1B).įigure 1A. These guidelines were then presented to the entire group for review and approval. 9-11 These activities and reviews led the pediatric trauma surgeons to develop algorithms for low-risk patients and high-risk patients. ![]() 6-7 As a first step, we convened multidisciplinary journal clubs to review the characteristics of pediatric c-spine injuries, including mechanisms of injury, imaging findings, and types of injuries. The planĪ multidisciplinary group of pediatric trauma surgeons, emergency medicine physicians, orthopaedic spine surgeons, neurosurgeons, and radiologists developed the c-spine clearance pathway through discussion and a thorough review of the literature and other available guidelines. Pediatric patients ages 12 and younger are managed by the pediatric surgery trauma team, and approximately 200 pediatric trauma admissions occur yearly. Pediatric specialty services offered include pediatric surgery, pediatric emergency medicine, pediatric orthopaedic surgery, pediatric neurosurgery, and pediatric radiology, among others. Pediatric patients were generally evaluated with the same workup used in adult patients and, quite often, a CT scan was obtained.īeaumont Children’s is a Level 2 pediatric trauma center and is housed on the campus of Beaumont Hospital Royal Oak, a 1,100-bed tertiary care and Level 1 adult trauma center. The decision for imaging often depended on the practices of the physician(s) seeing the patient rather than predefined clinical criteria and risk stratification. As a result, patients experienced variations in care. 6-8 The problemīeaumont Children’s Hospital/Beaumont Health, Royal Oak, MI, lacked any guidelines on c-spine clearance. Separate pathways for clearance of the pediatric c-spine have been found to be effective and reduce radiation exposure. An established algorithm for c-spine evaluation can help balance these conflicting ideals in clinical decision making. 5 Injuries cannot be missed, but patients at low risk for injury should not be subject to unnecessary radiation exposure early in their lives. Aggressive imaging in the pediatric patient population can be costly and may expose children to large amounts of radiation and, therefore, potential future malignancies. ![]() 4 Until recently, the c-spine workup at many institutions involved obtaining multiple c-spine films and often a complete c-spine computed tomography (CT) scan. 1-3 Although the incidence, characteristics, and severity of c-spine injuries differ between adult and pediatric populations, pediatric patients are generally subjected to the same traumatic workup of their c-spine as adult trauma patients. Pediatric cervical spine (c-spine) injuries are rare events, with an incidence of approximately 1 to 2 percent and potentially devastating consequences. ![]()
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