Nunn, C., Negus, S., Lawrence, T. et al. (2 more authors) (2021) Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data. Trauma, 23 (2). pp. 139-144. ISSN 1460-4086
Abstract
Background
Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates.
Methods
A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016.
Results
The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units.
Discussion
This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 The Author(s). This is an author produced version of a paper subsequently published in Trauma. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Computerised tomography; spine; children; guidance |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 05 Nov 2020 15:41 |
Last Modified: | 24 May 2022 09:41 |
Status: | Published |
Publisher: | SAGE Publications |
Refereed: | Yes |
Identification Number: | 10.1177/1460408620939381 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:167680 |
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Licence: CC-BY-NC-ND 4.0