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Analysis of Pediatric Cervical Spine Injury Evaluation Workflow in the Emergency Department
Journal article   Open access   Peer reviewed

Analysis of Pediatric Cervical Spine Injury Evaluation Workflow in the Emergency Department

Annie J. Truelove, Megan E. Gregory, Fahd A. Ahmad, Sean P. Pajak, Nicole C. Hammer, Daniel Corwin, Leah Tzimenatos, Scott O. King, Matthew Szadkowski, Martin J. Herman, …
Journal of the American College of Emergency Physicians Open, v 7(1), pp 100295-100295
Feb 2026
DOI: https://doi.org/10.1016/j.acepjo.2025.100295
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.acepjo.2025.100295View
Published, Version of Record (VoR) Open

Abstract

applied cognitive task analysis (ACTA) cervical spine injury (CSI) emergency department imaging pediatric
The decision to image children for cervical spine injuries (CSI), an uncommon injury with high associated morbidity and mortality, is complex. X-rays and computed tomography are often used to screen for CSI; however, radiation exposure increases lifetime cancer risk. We recently developed a CSI prediction rule to inform pediatric imaging decisions. To guide implementation, we conducted a workflow analysis of CSI screening in children after blunt trauma. We interviewed emergency departments (ED) and trauma clinicians at 21 hospitals following the applied cognitive task analysis task diagram, knowledge audit, and simulation interview approaches. Interviews were coded using a combined deductive-inductive approach to construct a workflow diagram and identify critical decisions with associated workflow junctures, decision makers, physical locations, and cognitive demands. We noted areas of high, medium, and low variability. We interviewed 48 participants (emergency medicine physicians and advanced practice providers [n = 22], nurses [n = 14], and surgeons [n = 12]) across 21 hospitals located in the Western (n = 15), Northeastern (n = 5), and Midwestern (n = 1) USA. Critical decisions within the pediatric CSI imaging decision workflow included trauma triaging, spinal motion restriction application, clinical clearance, decision to image, and imaging type. There was moderate-to-high variability between hospitals for most workflow junctures and decision makers. However, more consistent patterns emerged, such as a high level of ED and trauma attending involvement throughout the process. The knowledge audit revealed a heavy cognitive load associated with decision making. “Big picture,” “past and future,” “noticing”, “job smarts,” and “equipment” were highly relevant cognitive demands. Moderate-to-high between-hospital variability in workflow for decision making around CSI evaluation for pediatric trauma patients could potentially complicate CSI prediction rule implementation.

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Collaboration types
Domestic collaboration
Web of Science research areas
Emergency Medicine
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