title: Cervical spine computed tomography utilization in pediatric trauma patients.
abstract: BACKGROUND
  Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs).
  
  
  METHODS
  Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression.
  
  
  RESULTS
  5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p<0.05) and more frequent ICU admissions (44.3% vs. 26.1% p<0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI=8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI=25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT.
  
  
  CONCLUSIONS
  Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.
authors: Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO. Electronic address: kathleen.adelgais@childrenscolorado.org.
authors: Kathleen M
authors: KM
authors: Adelgais
authors: Department of Pediatrics, Pediatric Emergency Medicine Section, Medical College of Wisconsin, Milwaukee, WI.
authors: Lorin
authors: L
authors: Browne
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT.
authors: Maija
authors: M
authors: Holsti
authors: Department of Surgery, Division of Pediatric Surgery, University of Utah, Salt Lake City, UT.
authors: Ryan R
authors: RR
authors: Metzger
authors: Primary Care Partners, Grand Junction, CO.
authors: Shannon Cox
authors: SC
authors: Murphy
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT.
authors: Nanette
authors: N
authors: Dudley
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D012042:Registries; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014589:Utah
keywords: Computed tomography; Pediatric; Trauma