New research suggests screening kids for cervical spine injury (CSI) risk factors could reduce unnecessary CT scans by 50%, significantly limiting radiation exposure.
Although CSI is a serious medical condition it is a rare one, wrote lead author Julie Leonard, MD, MPH, in a new release. Despite this, CSI testing has jumped by 400% over the past 20 years; most clinicians have switched from performing x-rays, with limited radiation, to CT scans, which require much more exposure.
"We need to be able to quickly decide which children have serious injuries and provide them the highest level of care and service," Leonard, with The Ohio State University College of Medicine, said in the release. "But we don't want to subject the large majority of children, who have experienced a traumatic event but have minor injuries, to unnecessary and potentially harmful testing and interventions."
The researchers prospectively enrolled 4,091 children (ages 0 to 17 years old) across four children’s hospitals in their study, 74 of whom had CSIs. Patients had experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation and/or cervical imaging.
After reviewing images, consultations and/or phone follow-ups, the team identified 14 factors with bivariable associations with CSIs. Seven of these were determined to be most useful for classifying patients with CSI.
The method based on seven risk factors produced a sensitivity and specific of 92% and 50.3%, respectively. The other model was slightly less sensitive (90.5%) and specific (45%).
And based of prior research that determined for every 1,000 CT scan in kids, one to two new cancers are induced, Leonard and colleagues estimated many kids could be spared from unnecessary pain.
"If you cut the current number of CT scans for cervical spine injury in half, each year you spare hundreds of children from cancer,” Leonard added.
The current study is a first-year undertaking, part of a larger five-year national study that will include more than 20,000 kids. Leonard and her team expect their model’s performance to improve and ultimately create a pediatric CSI risk assessment tool for clinicians.
"Historically, the line of reasoning given by general physicians and adult emergency physicians for these scans is that children are difficult to evaluate and don't have identifiable risk factors," Leonard said. "This study shows there are risk factors physicians can use to screen children for CSI that can help aid their decision-making as to which children warrant radiographic testing and which children can be cleared based on history and a physical exam."
The full study was published online in Pediatrics.