Assuntos
Serviços Médicos de Emergência/normas , Tratamento de Emergência/normas , Índices de Gravidade do Trauma , Triagem/normas , Ferimentos e Lesões , Adulto , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapiaRESUMO
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.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Segurança do Paciente , Melhoria de Qualidade , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Doses de Radiação , Proteção Radiológica , Estudos Retrospectivos , Centros de TraumatologiaAssuntos
Alcoolismo/complicações , Alcoolismo/tratamento farmacológico , Traumatismo Múltiplo/complicações , Síndrome de Abstinência a Substâncias/complicações , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Dissuasores de Álcool/administração & dosagem , Benzodiazepinas/administração & dosagem , Diagnóstico Diferencial , Humanos , Traumatismo Múltiplo/metabolismo , Traumatismo Múltiplo/terapia , N-Metilaspartato/metabolismo , Neurotransmissores/metabolismo , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/metabolismo , Índices de Gravidade do Trauma , Ácido gama-Aminobutírico/metabolismoRESUMO
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.