Variation in the Self-Reported Use of Computed Tomography in Clearing the Cervical Spine of Pediatric Trauma Patients

Objective: Cervical spine injury (CSI) in children can be life-threatening or associated with lifelong disabilities. Whereas screening computed tomography (CT) of the cervical spine is used in the evaluation of adult trauma patients, it has no additional benefit in children when compared with plain film radiography of the cervical spine. Despite this, CT use in the pediatric patient is increasing. We sought to compare the self-reported utilization of screening cervical spine CT among pediatric emergency medicine (PEM) physicians and general emergency medicine (non-PEM) physicians. Methods: Physicians completed an online survey consisting of a clinical vignette in which the respondents chose to evaluate a pediatric trauma patient for CSI using no imaging, plain films, or CT. Questions regarding the physician's attitudes, knowledge, and practice patterns for pediatric CSI were included. Results: Six hundred fifty-four physicians responded to the survey: 463 (70.8%) non-PEM and 191 (29.2%) PEM physicians. Both groups ordered radiographic imaging at a similar rate, although non-PEM physicians were 4 times more likely to utilize CT than PEM practitioners. Non-PEM physicians were more likely to overestimate the frequency of pediatric CSI. Pediatric emergency medicine physicians were more likely to state that they would never use CT as the initial modality for CSI screening. Conclusions: In response to a clinical vignette, non-PEM physicians were more likely to self-report the use of screening CT in pediatric trauma patients than PEM physicians.