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{
    "pk": 17494,
    "title": "Factors Associated with Overutilization of Computed Tomography of the Cervical Spine",
    "subtitle": null,
    "abstract": "Introduction:\n Despite the wide availability of clinical decision rules for imaging of the cervical spine after a traumatic injury (eg, NEXUS C-spine rule and Canadian C-spine rule), there is significant overutilization of computed tomography (CT) imaging in patients who are deemed to be at low risk for a clinically significant cervical spine injury by these clinical decision rules. The purpose of this study was to identify the major factors associated with the overuse of CT cervical spine imaging using a logistic regression model.\nMethods: \nThis was a retrospective review of all adult patients who underwent CT cervical spine imaging for evaluation of a traumatic injury at a tertiary academic emergency department (ED) and three affiliate community EDs in January and February 2019. We performed multivariable logistic regression to identify factors associated with obtaining CT cervical spine imaging despite low-risk classification by the NEXUS C-spine Rule.\nResults:\n A total of 1,051 patients underwent CT cervical spine imaging for traumatic indications during the study period, and 889 patients were included in the analysis. Of these patients, 376 (42.3%) were negative by the NEXUS C-spine rule. Variables that were associated with increased likelihood of unnecessary imaging included age over 65, Emergency Severity Index (ESI) score 2 and 3, arrival as a walk-in, and anticoagulation status. Patients who presented to the tertiary academic ED had a significantly lower likelihood of unnecessary imaging. Twenty-one patients (2.4%) were found to have cervical spine fractures on imaging, two of whom were negative by the NEXUS C-spine rule, but neither had a clinically significant fracture.\nConclusion:\n Cervical spine imaging is vastly overused in patients presenting to the ED with traumatic injuries, as adjudicated using the NEXUS C-spine rule as a reference standard. Older age, ESI level, arrival as a walk-in, and taking anticoagulation drugs were associated with overutilization of CT imaging. Conversely, presenting to the tertiary academic ED was associated with a lower likelihood of undergoing unnecessary imaging. This model can guide future interventions to optimize ED CT utilization and minimize unnecessary testing.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Emergency Medicine"
        },
        {
            "word": "emergency department"
        },
        {
            "word": "computed tomography"
        },
        {
            "word": "Cervical Spine"
        },
        {
            "word": "resource utilization"
        }
    ],
    "section": "Trauma",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/62r2j5q5",
    "frozenauthors": [
        {
            "first_name": "Karl",
            "middle_name": "T.",
            "last_name": "Chamberlin",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Maureen",
            "middle_name": "M.",
            "last_name": "Canellas",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Martin",
            "middle_name": "A.",
            "last_name": "Reznek",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Kevin",
            "middle_name": "A.",
            "last_name": "Kotkowski",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2022-09-20T03:06:35Z",
    "date_accepted": "2022-09-20T03:06:35Z",
    "date_published": "2023-08-28T19:22:45Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/17494/galley/8917/download/"
        }
    ]
}