• Tellen D Bennett, Susan L Bratton, Jay Riva-Cambrin, Eric R Scaife, Michael L Nance, Jeffrey S Prince, Jacob Wilkes, and Heather T Keenan.
• From the *Departments of Pediatric Critical Care, †Pediatric Neurosurgery, and ‡Pediatric Surgery, University of Utah, Primary Children's Medical Center, Salt Lake City, UT; §Department of Pediatric Surgery, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; and Departments of ∥Pediatric Radiology, Primary Children's Medical Center and ¶Pediatrics, University of Utah, Salt Lake City, UT.
• Pediatr Emerg Care. 2015 Apr 1;31(4):243-9.

ObjectivesThe purposes of this study, in children with traumatic brain injury (TBI), to describe cervical spine imaging practice, to assess for recent changes in imaging practice, and to determine whether cervical spine computed tomography (CT) is being used in children at low risk for cervical spine injury.MethodsThe setting was children's hospitals participating in the Pediatric Health Information System database, from January 2001 to June 2011. Participants were children (younger than 18 y) with TBI who were evaluated in the emergency department, admitted to the hospital, and received a head CT scan on the day of admission. The primary outcome measures were cervical spine imaging studies. This study was exempted from institutional review board assessment.ResultsA total of 30,112 children met study criteria. Overall, 52% (15,687/30,112) received cervical spine imaging. The use of cervical spine radiographs alone decreased between 2001 (47%) and 2011 (23%), with an annual decrease of 2.2% (95% confidence interval [CI], 1.1%-3.3%), and was largely replaced by an increased use of CT, with or without radiographs (8.6% in 2001 and 19.5% in 2011, with an annual increase of 0.9%; 95% CI, 0.1%-1.8%). A total of 2545 children received cervical spine CT despite being discharged alive from the hospital in less than 72 hours, and 1655 of those had a low-risk mechanism of injury.ConclusionsThe adoption of CT clearance of the cervical spine in adults seems to have influenced the care of children with TBI, despite concerns about radiation exposure.

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