Gary R. Fleisher

ACADEMIC EMERGENCY MEDICINE 2011; 18:906–911 © 2011 by the Society for Academic Emergency Medicine Objectives:  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.

Geographic circumstances: We participated intimately in disaster response after Hurricane Katrina's landfall and other disasters since then. About the lead author (Dr Weiner): I am a pediatric emergency medicine physician at Children's Hospital Boston (CHB)/Harvard Medical School (HMS) and the CHB representative and a charter member of the HMS Section on Disaster Medicine. I have been a National Disaster Medical System member on the Disaster Medical Assistance Team, the International Medical Surgical Response Team, and the Pediatric Specialty Team since 1995. I am a member of the American Academy of Pediatrics Extended Disaster Preparedness Advisory Council Network. I have served as a domestic and international consultant in disaster planning and am developing technology-based resources for disaster training and response. Hurricane Katrina was a disaster unlike others for which the US National Disaster Medical System (NDMS) had been deployed. Never before had the NDMS attempted to provide sustained disaster relief over a geographic area as expansive as the multistate region devastated first by Hurricane Katrina and then by Hurricane Rita. There were challenges we anticipated and those that we did not. Lessons learned from Hurricanes Katrina and Rita, and subsequent disasters, have led and continue to lead to strategic conceptual, organizational, and operational modifications to improve care to disaster victims.1 Increased emphasis on the care of children in disasters is an important component of these initiatives, given that for most disasters more than one-third of victims are children.2 As demonstrated by the hurricanes in the Gulf Coast region, and again by the earthquake in Haiti in January 2010, the NDMS remains a critical asset for disaster relief and one of the few US disaster-relief organizations/agencies with the capacity to provide care for critically injured or ill disaster victims including children. Lessons learned from and actions taken since Hurricanes Katrina … Address correspondence to Debra L. Weiner, MD, PhD, Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail: debra.weiner{at}childrens.harvard.edu