National Healthcare Quality and Disparities Report
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- Access to Care (2)
- Adverse Events (1)
- Back Health and Pain (1)
- Brain Injury (1)
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- Cancer: Breast Cancer (3)
- Cancer: Lung Cancer (3)
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- Elderly (1)
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- (-) Imaging (22)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedHolcomb J, Ferguson G, Roth I
Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics.
This paper describes an evidence-based intervention that was created to reduce mammography appointment no-show rates in underserved women at safety net clinics. An academic-community partnership was used to implement four strategies to improve the adoption and scale-up of the interventions with Federally Qualified Health Centers and charity care clinics. The interventions implemented were: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers.
AHRQ-funded; HS023255.
Citation: Holcomb J, Ferguson G, Roth I .
Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics.
Front Public Health 2021 Nov 4;9:748361. doi: 10.3389/fpubh.2021.748361..
Keywords: Evidence-Based Practice, Imaging, Screening, Women, Community-Based Practice
Zou WY, Enchakalody BE, Zhang P
Automated measurements of body composition in abdominal CT scans using artificial intelligence can predict mortality in patients with cirrhosis.
Body composition measures derived from already available electronic medical records (computed tomography [CT] scans) can have significant value, but automation of measurements is needed for clinical implementation. I this study, the investigators sought to use artificial intelligence to develop an automated method to measure body composition and test the algorithm on a clinical cohort to predict mortality.
AHRQ-funded; HS027183.
Citation: Zou WY, Enchakalody BE, Zhang P .
Automated measurements of body composition in abdominal CT scans using artificial intelligence can predict mortality in patients with cirrhosis.
Hepatol Commun 2021 Nov;5(11):1901-10. doi: 10.1002/hep4.1768..
Keywords: Imaging, Health Information Technology (HIT)
Moazzezi M, Rose B, Kisling K
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
This study’s objective was to assess the new online adaptive radiation therapy technology called Ethos for treating prostate cancer. Twenty-five prostate patients previously treated at the author’s clinic were re-planed using an Ethos emulator. Clinical margins of 3 mm posterior, 5 mm left/right/anterior, and 7 mm superior/inferior were used. Dose metrics were compared to unadapted plans to evaluate clinical target volumes (CTV) and online adaptive radiation (OAR) dose changes. Overall, 96% of fractions required auto-segmentation edits, although they were mostly minor. Adaptation improved CTV 98% for the 24 patients with minor auto-segmentation corrections. However, for one in 25 patients, large contour edits were required.
AHRQ-funded; HS025440.
Citation: Moazzezi M, Rose B, Kisling K .
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
J Appl Clin Med Phys 2021 Oct;22(10):82-93. doi: 10.1002/acm2.13399..
Keywords: Cancer: Prostate Cancer, Cancer, Treatments, Imaging
Marin JR, Rodean J, Mannix RC
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
The objective of this study was to examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) were associated with lower head computed tomography (CT) use. The investigators concluded that clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Mannix RC .
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
J Pediatr 2021 Aug;235:178-83.e1. doi: 10.1016/j.jpeds.2021.04.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Brain Injury, Guidelines, Evidence-Based Practice, Imaging
Patterson BW, Johnson J, Ward MD
Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.
The objective of this study was to compare the rate and clinical yield of computed tomography (CT) imaging between patients presenting with abdominal pain initially seen by a physician in triage (PIT) versus those seen only by physicians working in the main emergency department (ED). For patients with abdominal pain, the investigators found no significant differences in rates of CT ordering or CT yield for patients seen in a PIT vs. traditional models.
AHRQ-funded; HS024558.
Citation: Patterson BW, Johnson J, Ward MD .
Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.
Am J Emerg Med 2021 Aug;46:160-64. doi: 10.1016/j.ajem.2020.05.119..
Keywords: Imaging, Emergency Department, Practice Patterns, Diagnostic Safety and Quality
Gerber DE, Hamann HA, Dorsey O
Clinician variation in ordering and completion of low-dose computed tomography for lung cancer screening in a safety-net medical system.
Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined. In this study the investigators examined medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. The investigators concluded that in an integrated safety-net healthcare system, most adult primary care providers ordered LDCT.
AHRQ-funded; HS022418.
Citation: Gerber DE, Hamann HA, Dorsey O .
Clinician variation in ordering and completion of low-dose computed tomography for lung cancer screening in a safety-net medical system.
Clin Lung Cancer 2021 Jul;22(4):e612-e20. doi: 10.1016/j.cllc.2020.12.001..
Keywords: Imaging, Cancer: Lung Cancer, Cancer
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation: Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Long S, Thomas GW, Karam MD
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
This study introduces and evaluates a novel Image-based Decision Error Analysis (IDEA) score that captures performance during fluoroscopically assisted wire navigation. Findings showed that the fluoroscopic images obtained in the course of placing a guide wire contained a rich amount of information related to surgical skill. The IDEA scoring provided a basis for evaluating the competence of a resident. The score can be used to assess skill at key timepoints throughout residency, such as when rotating onto/off of a new surgical service and before performing certain procedures in the operating room, or as a tool for debriefing/providing feedback after a procedure is completed.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Karam MD .
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
Clin Orthop Relat Res 2021 Jun;479(6):1386-94. doi: 10.1097/corr.0000000000001623..
Keywords: Orthopedics, Surgery, Decision Making, Medical Errors, Adverse Events, Imaging
Whaley CM, Zhao X, Richards M
Higher Medicare spending on imaging and lab services after primary care physician group vertical integration.
This study looked at the impact of direct ownership of physician practices by hospitals and health systems (vertical integration) on Medicare spending for imaging and lab services. A 100% sample of 2013-16 Medicare fee-for-service claims data was examined to determine if vertical integration was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries increased in a hospital setting by 26.3 per 1000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests. This translates to $40.2 million increase for imaging and $32.9 million increase for laboratory tests in Medicare spending for the study period.
AHRQ-funded; HS024067.
Citation: Whaley CM, Zhao X, Richards M .
Higher Medicare spending on imaging and lab services after primary care physician group vertical integration.
Health Aff 2021 May;40(5):702-09. doi: 10.1377/hlthaff.2020.01006..
Keywords: Medicare, Healthcare Costs, Imaging, Primary Care
Ricci KB, Oslock WM, Ingraham AM
Importance of radiologists in optimizing outcomes for older Americans with acute abdomen.
Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. The authors of this study investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or "acute abdomen," in older Americans. The investigators concluded that delays obtaining results were associated with adverse outcomes in older patients with acute abdomen.
AHRQ-funded; HS022694.
Citation: Ricci KB, Oslock WM, Ingraham AM .
Importance of radiologists in optimizing outcomes for older Americans with acute abdomen.
J Surg Res 2021 May;261:361-68. doi: 10.1016/j.jss.2020.12.022..
Keywords: Elderly, Imaging, Diagnostic Safety and Quality
Desai S, Kapoor N, Hammer MM
RADAR: a closed-loop quality improvement initiative leveraging a safety net model for incidental pulmonary nodule management.
This study was conducted to assess whether patients with incidental pulmonary nodules (IPNs) received timely follow-up care after implementation of a quality improvement (QI) initiative between radiologists and primary care providers. A QI initiative, RADAR (Radiology Result Alert and Development of Automated Resolution), was implemented. Findings showed that the RADAR QI initiative was associated with increased timely IPN follow-up.
AHRQ-funded; HS024722.
Citation: Desai S, Kapoor N, Hammer MM .
RADAR: a closed-loop quality improvement initiative leveraging a safety net model for incidental pulmonary nodule management.
Jt Comm J Qual Patient Saf 2021 May;47(5):275-81. doi: 10.1016/j.jcjq.2020.12.006..
Keywords: Quality Improvement, Quality of Care, Diagnostic Safety and Quality, Imaging
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Murphy AM, Qiu Q .
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Cavallaro SC, Monuteaux MC, Chaudhari PP
Use of neuroimaging for children with seizure in general and pediatric emergency departments.
Investigators sought to compare rates of head computed tomography (CT) scans for pediatric seizure between general and pediatric emergency departments (EDs). Subjects were patients 21 years of age or less who presented to an ED with a chief complaint or diagnosis of seizure. They investigators found that general EDs obtained CT scans of the head more often in patients with epilepsy, without fever, and without trauma. They concluded that children with seizure were more likely to undergo CT scans of the head at general EDs compared with pediatric EDs.
AHRQ-funded; HS026503.
Citation: Cavallaro SC, Monuteaux MC, Chaudhari PP .
Use of neuroimaging for children with seizure in general and pediatric emergency departments.
J Emerg Med 2021 Apr;60(4):478-84. doi: 10.1016/j.jemermed.2020.10.044..
Keywords: Children/Adolescents, Emergency Department, Imaging, Neurological Disorders
Schoenfeld EM, Poronsky KE, Westafer LM
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Both ultrasound and CT scan can be used for diagnosis of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone), but the majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. The investigators developed a decision aid to facilitate SDM in this scenario. The objective of this study was to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Poronsky KE, Westafer LM .
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Trials 2021 Mar 10;22(1):201. doi: 10.1186/s13063-021-05140-9..
Keywords: Emergency Department, Decision Making, Kidney Disease and Health, Imaging, Diagnostic Safety and Quality
Meza R, Jeon J, Toumazis I
Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force.
The purpose of this study was to inform the USPSTF guidelines by estimating the benefits and harms associated with various low-dose computed tomography (LDCT) screening strategies. Microsimulation modeling studies suggested that LDCT screening for lung cancer compared with no screening may increase lung cancer deaths averted and life-years gained when optimally targeted and implemented. Screening individuals at aged 50 or 55 years through aged 80 years with 20 pack-years or more of smoking exposure was estimated to result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity.
AHRQ-funded; 290201500011I.
Citation: Meza R, Jeon J, Toumazis I .
Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force.
JAMA 2021 Mar 9;325(10):988-97. doi: 10.1001/jama.2021.1077..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Imaging, Screening, Prevention, Evidence-Based Practice, Guidelines
Jonas DE, Reuland DS, Reddy SM
Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the USPSTF. Findings showed that screening high-risk persons with LDCT can reduce lung cancer mortality but can also cause false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers.
AHRQ-funded; 290201500011I.
Citation: Jonas DE, Reuland DS, Reddy SM .
Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2021 Mar 9;325(10):971-87. doi: 10.1001/jama.2021.0377..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Imaging, Screening, Prevention, Evidence-Based Practice
Miglioretti DL, Bissell MCS, Kerlikowske K
Assessment of a risk-based approach for triaging mammography examinations during periods of reduced capacity.
Breast cancer screening, surveillance, and diagnostic imaging services were profoundly limited during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. The objective of this population-based cohort study was to develop a risk-based strategy for triaging mammograms during periods of decreased capacity. The investigators found that clinical indication and individual risk factors were associated with cancer detection and suggest these may be useful for prioritizing mammography in times and settings of decreased capacity.
AHRQ-funded; HS018366.
Citation: Miglioretti DL, Bissell MCS, Kerlikowske K .
Assessment of a risk-based approach for triaging mammography examinations during periods of reduced capacity.
JAMA Netw Open 2021 Mar;4(3):e211974. doi: 10.1001/jamanetworkopen.2021.1974..
Keywords: Screening, Cancer: Breast Cancer, Cancer, Women, Imaging, Access to Care, COVID-19
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Lee CI, Zhu W, Onega T
Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.
This study looked at access to digital breast tomography (DBT) versus regular mammography and whether women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early adoption period and persistently lower DBT use over time. This cross-sectional study included 92 geographically diverse imaging facilities across 5 US states, with over 2.3 million screening examinations performed among women aged 40 to 89 years from January 1, 2011, to December 31, 2017. Data were analyzed from June 2019, to August 2020. Women who used DBT increased for all women from 3.3% in 2011 to 82.6% in 2017. In 2012, Black, Hispanic, Asian American, and women with less than a high school education had lower DBT access compared to White women attending the same facility and also college graduates. Lower DBT access continued over time regardless of the number of years after facility-level DBT adoption.
AHRQ-funded; HS018366.
Citation: Lee CI, Zhu W, Onega T .
Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.
JAMA Netw Open 2021 Feb;4(2):e2037546. doi: 10.1001/jamanetworkopen.2020.37546..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Access to Care, Women, Social Determinants of Health, Racial and Ethnic Minorities, Screening
Lacson R, Cochon L, Ching PR
Integrity of clinical information in radiology reports documenting pulmonary nodules.
Researchers sought to quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports, and to assess impact on making follow-up recommendations. Their retrospective cohort study was performed at an academic medical center and natural language processing was used on radiology reports of CT scans of chest, abdomen, or spine to assess presence of pulmonary nodules. They found that essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up. They concluded that the lack of documentation of pulmonary nodule characteristics in radiology reports was common, with the potential for compromising patient care and clinical decision support tools.
AHRQ-funded; HS024722.
Citation: Lacson R, Cochon L, Ching PR .
Integrity of clinical information in radiology reports documenting pulmonary nodules.
J Am Med Inform Assoc 2021 Jan 15;28(1):80-85. doi: 10.1093/jamia/ocaa209..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Marin JR, Rodean J, Hall M
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
Researchers evaluated racial and ethnic differences in the performance of common ED imaging studies and examined patterns across diagnoses. In this study, which evaluated visits by nonhospitalized patients younger than 18 years in 44 US children's hospital EDs, they found that non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. They recommended further investigation to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
JAMA Netw Open 2021 Jan 4(1):e2033710. doi: 10.1001/jamanetworkopen.2020.33710..
Keywords: Children/Adolescents, Hospitals, Emergency Department, Imaging, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Henry MK, French B, Feudtner C
Cervical spine imaging and injuries in young children with non-motor vehicle crash-associated traumatic brain injury.
Researchers evaluated cervical magnetic resonance imaging and computed tomography practices and cervical spine injuries among a stratified random sample of young children with non-motor vehicle crash-associated traumatic brain injury (TBI). They found that abusive head trauma victims appeared to be at increased risk of cervical injuries. They recommended prospective studies to define the risk of cervical injury in children with TBI concerning for abusive head trauma and to inform development of imaging guidelines.
AHRQ-funded; HS024194.
Citation: Henry MK, French B, Feudtner C .
Cervical spine imaging and injuries in young children with non-motor vehicle crash-associated traumatic brain injury.
Pediatr Emerg Care 2021 Jan;37(1):e1-e6. doi: 10.1097/pec.0000000000001455..
Keywords: Children/Adolescents, Imaging, Injuries and Wounds, Injuries and Wounds, Emergency Department