Cost and Time-Effective Strategies:
1. Clinically clear the cervical spine when possible. Avoiding radiographic studies saves not only their cost, but also time in the emergency room.
2. Don’t waste a lot of time or effort on getting the odontoid view. Successful attempts to obtain this view are rare in children under the age of 9 years.
3. If ordering a head CT, consider extending it to include the cervical spine from the occiput to C2. This eliminates the need for an odontoid and guarantees adequate visualization of the area most prone to injury in the small child.
4. If the patient has cervical pain or an abnormality on plain film, consult an expert early. An orthopedic surgeon or neurosurgeon may have preferences about which further studies will be done. This can prevent redundant or unnecessary imaging.
5. REMEMBER: The cost of a missed injury is far greater than the cost of additional imaging. During the time period from 1997 to 2000, the average hospital bill for a pediatric CSI patient was $57,280, and the average length of hospital stay was 13.47 days.
