Decision-making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department.
clinical decision support
imaging
pediatric trauma
teamwork
Journal
Journal of the American College of Emergency Physicians open
ISSN: 2688-1152
Titre abrégé: J Am Coll Emerg Physicians Open
Pays: United States
ID NLM: 101764779
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
25
04
2023
revised:
11
07
2023
accepted:
26
07
2023
medline:
21
8
2023
pubmed:
21
8
2023
entrez:
21
8
2023
Statut:
epublish
Résumé
Cervical spine imaging decision-making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department-trauma team dynamics may affect implementation of such a tool. We interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision-making process. Data were coded following a framework-driven deductive coding process and thematic analysis was used. Forty-eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I-III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision-making process. Implementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.
Identifiants
pubmed: 37600900
doi: 10.1002/emp2.13024
pii: EMP213024
pmc: PMC10432897
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e13024Informations de copyright
© 2023 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
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