Use of Helical Computed Tomography for Imaging the Pediatric Cervical Spine

Objective: To determine the differences in resource utilization and radiation exposure between conventional radiography (ConvRad) and helical computed tomography (HCT) when used to survey the pediatric cervical spine (CSp). Methods: Patients aged 0-14 years who required CSp radiographic evaluation in addition to cranial CT were prospectively enrolled and assigned to undergo either HCT or ConvRad with adjunctive linear tomography. Outcomes of medication usage, emergency department (ED) length of stay (LOS), cervical spine radiation exposure, and imaging resource use (relative value unit [RVU]) were compared between the two groups. Data were analyzed by regression analysis with adjustment for confounders. Results: Of 136 patients, 64 and 72 patients were assigned to the ConvRad group and HCT group, respectively. At the discretion of the trauma team, 34% of the patients enrolled crossed between the two study arms. Odds ratio (OR), based on original assignment, was 0.8 (95% CI = 0.4 to 1.8) for difference in medication usage between the two groups. Mean LOSs were 259 minutes (95% CI = 124 to 394) and 183 (95% CI = 166 to 200) minutes for HCT and ConvRad, respectively. CSp imaging RVUs were 5.5 (95% CI = 5.1 to 5.8) for HCT and 4.0 (95% CI = 3.3 to 4.6) for ConvRad. Mean CSp radiation doses were 389 mRem (95% CI = 346 to 432) for HCT and 294 mRem (95% CI = 245 to 343) for ConvRad. Adjustment for confounders did not change the direction of the results. Conclusions: As a modality to screen the pediatric CSp for blunt-force trauma, HCT results in increased radiation exposure and radiology resource use without a reduction in sedation usage or time in the ED.