Subject(s)
Emergency Medical Services/standards , Emergency Treatment/standards , Trauma Severity Indices , Triage/standards , Wounds and Injuries , Adult , Emergency Medical Services/statistics & numerical data , Emergency Treatment/statistics & numerical data , Female , Humans , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Wounds and Injuries/diagnosis , Wounds and Injuries/therapyABSTRACT
BACKGROUND: Morbidity and mortality of cervical spine (C-spine) injury in pediatric trauma patients are high, necessitating quick and accurate diagnosis. Best practices emphasize minimizing radiation exposure through decreased reliance on computed tomography (CT), instead using clinical assessment, physical examination, and alternate imaging techniques. We implemented an institutional performance improvement and patient safety (PIPS) program initiative for C-spine clearance in 2010 because of high rates of CT scans among pediatric trauma patients. METHODS: A retrospective review of pediatric trauma patients, aged 0 years to 14 years, in the pre- and post-PIPS implementation periods was conducted. Rates of C-spine CT, overall CT, other imaging modalities, radiation exposure, patient characteristics, and injury severity were compared, and compliance with PIPS protocol was reviewed. RESULTS: Patient characteristics and injury severity were similar before and after PIPS implementation. C-spine CT rates decreased significantly between groups (30% vs. 13%, p < 0.001), whereas C-spine plain x-ray rates increased significantly (7% vs. 25%, p < 0.001). There was no difference in C-spine magnetic resonance imaging between groups (12% vs. 10%, p = 0.11). In 2007, 71% of patients received a CT scan for any reason. However, the overall CT rate decreased significantly between groups (60% vs. 45%, p < 0.001). There was an estimated 22% decrease in lifetime attributable risk (LAR) for any cancer due to ionizing imaging exposure in males and 38% decrease in females between the pre- and post-PIPS groups. There was a 54% decrease in LAR for thyroid cancer in males and females between groups; 2014 compliance with the protocol was excellent (82-90% per quarter). CONCLUSIONS: Performance improvement and patient safety program-generated protocol can significantly decrease ionizing radiation exposure. We demonstrate that a simple protocol focused on C-spine imaging has high compliance, decreased C-spine CT scans, and decreased LAR for thyroid cancer. A secondary benefit is a reduction in total CT imaging, with an associated decrease in LAR for all cancers. LEVEL OF EVIDENCE: Therapeutic study, level IV; diagnostic study, level III.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Patient Safety , Quality Improvement , Spinal Injuries/diagnostic imaging , Tomography, X-Ray Computed/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Injury Severity Score , Magnetic Resonance Imaging/statistics & numerical data , Male , Radiation Dosage , Radiation Protection , Retrospective Studies , Trauma CentersSubject(s)
Alcoholism/complications , Alcoholism/drug therapy , Multiple Trauma/complications , Substance Withdrawal Syndrome/complications , Substance Withdrawal Syndrome/drug therapy , Alcohol Deterrents/administration & dosage , Benzodiazepines/administration & dosage , Diagnosis, Differential , Humans , Multiple Trauma/metabolism , Multiple Trauma/therapy , N-Methylaspartate/metabolism , Neurotransmitter Agents/metabolism , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/metabolism , Trauma Severity Indices , gamma-Aminobutyric Acid/metabolismABSTRACT
The Oregon State Legislature approved a statewide trauma system in 1985. Regional trauma committees, known as area trauma advisory boards, were prescribed by this legislation. The area trauma advisory board in Region 1 in the Northwest corner of Oregon includes the only 2 level 1 trauma centers in the entire state and began meeting in 1988. The peer review subcommittee, Trauma Audit Group, serves as an interhospital peer review body with a 22-year history as a model of successful systemwide quality improvement committee.
