title: Factors associated with the use of cervical spine computed tomography imaging in pediatric trauma patients.
abstract: OBJECTIVE
  The objectives were to identify patient and hospital characteristics associated with the use of computed tomography (CT) imaging of the cervical spine (c-spine) in the evaluation of injured children and, in particular, to examine the influence of hospital setting.
  
  
  METHODS
  This was a retrospective cohort of children younger than 19 years of age from the Massachusetts Hospital Emergency Department (ED) database who were discharged from the ED with an injury diagnosis from 2005 through 2009. Multivariable logistic regression was used to analyze characteristics associated with CT imaging of the c-spine.
  
  
  RESULTS
  Of the 929,626 pediatric patients diagnosed with an injury in Massachusetts EDs and then discharged home, 1.3% underwent CT imaging of the c-spine. Rates of CT imaging nearly doubled over the 5 years. In the multivariable model, patient age (adjusted odds ratio [AOR] = 2.3, 95% confidence interval [CI] = 2.0 to 2.7 for children age 12 to 18 years vs. under 1 year of age) and evaluation outside of a pediatric Level I trauma center (AOR = 2.2, 95% CI = 1.1 to 4.3 for children evaluated at non Level I trauma centers vs. pediatric Level I trauma centers; AOR = 2.1, 95% CI = 0.93 to 4.7 for children evaluated at adult Level I trauma centers vs. pediatric Level I trauma centers) were associated with higher rates of CT imaging of the c-spine.
  
  
  CONCLUSIONS
  Cervical spine CT imaging for children discharged from the ED with trauma diagnoses increased from 2005 through 2009. Older age and evaluation outside a Level I pediatric trauma center were associated with a higher c-spine CT rate. Educational interventions focused outside pediatric trauma centers may be an effective approach to decreasing CT imaging of the c-spine of pediatric trauma patients.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, MA, USA. Rebekah.Mannix@childrens.harvard.edu
authors.forename: Rebekah
authors.initials: R
authors.lastname: Mannix
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Sara A
authors.initials: SA
authors.lastname: Schutzman
authors.forename: Kara
authors.initials: K
authors.lastname: Hennelly
authors.forename: Florence T
authors.initials: FT
authors.lastname: Bourgeois
authors.forename: William P
authors.initials: WP
authors.lastname: Meehan
authors.forename: Gary
authors.initials: G
authors.lastname: Fleisher
authors.forename: Michael
authors.initials: M
authors.lastname: Monuteaux
authors.forename: Lois K
authors.initials: LK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*