Objective Motor vehicle crash (MVC)-related spinal injuries result in significant morbidity and mortality in children. The objective was to identify MVC-related injury causation scenarios for spinal injuries in restrained children. Methods This was a case series of occupants in MVCs from the Crash Injury Research and Engineering Network (CIREN) data set. Occupants aged 0–17 years old with at least one Abbreviated Injury Scale (AIS) 2+ severity spinal injury in vehicles model year 1990+ that did not experience a rollover were included. Unrestrained occupants, those not using the shoulder portion of the belt restraint, and those with child restraint gross misuse were excluded. Occupants with preexisting comorbidities contributing to spinal injury and occupants with limited injury information were also excluded. A multidisciplinary team retrospectively reviewed each case to determine injury causation scenarios (ICSs). Crash conditions, occupant and restraint characteristics, and injuries were qualitatively summarized. Results Fifty-nine cases met the study inclusion criteria and 17 were excluded. The 42 occupants included sustained 97 distinct AIS 2+ spinal injuries (27 cervical, 22 thoracic, and 48 lumbar; 80 AIS-2, 15 AIS-3, 1 AIS-5, and 1 AIS-6), with fracture as the most common injury type (80%). Spinal-injured occupants were most frequently in passenger cars (64%), and crash direction was most often frontal (62%). Mean delta-V was 51.3 km/h ± 19.4 km/h. The average occupant age was 12.4 ± 5.3 years old, and 48% were 16- to 17-year-olds. Thirty-six percent were right front passengers and 26% were drivers. Most occupants were lap and shoulder belt restrained (88%). Non-spinal AIS 2+ injuries included those of the lower extremity and pelvis (n = 56), head (n = 43), abdomen (n = 39), and thorax (n = 36). Spinal injury causation was typically due to flexion or lateral bending over the lap and or shoulder belt or child restraint harness, compression by occupant’s own seat back, or axial loading through the seat pan. Nearly all injuries in children <12 years occurred by flexion over a restraint, whereas teenage passengers had flexion, direct contact, and other ICS mechanisms. All of the occupants with frontal flexion mechanism had injuries to the lumbar spine, and most (78%) had associated hollow or solid organ abdominal injuries. Conclusions Restrained children in nonrollover MVCs with spinal injuries in the CIREN database are most frequently in high-speed frontal crashes, of teenage age, and have vertebral fractures. There are age-specific mechanism patterns that should be further explored. Because even moderate spinal trauma can result in measurable morbidity, future efforts should focus on mitigating these injuries.

Background: Ventricular arrhythmias (VAs) are the most lethal arrhythmias. Established therapies to prevent VAs include anti-arrhythmic drugs (AADs) and catheter ablation (CA). For patients with recurrent VAs despite AADs and CA, novel therapies such as cardiac sympathetic denervation (CSD) and stereotactic body radiation therapy (SBRT) exist. This study reports outcomes of CSD and SBRT at a tertiary care academic center. Methods: Study comprises all patients undergoing CSD or SBRT at one center from 10/2018 - 10/2021. Patients with less than 2 months of follow-up were excluded. Retrospective chart review was performed to collate data for demographics, clinical characteristics, arrhythmia burden before and after novel therapies (maximum 12 months), and treatment complications. VA burden in the form of anti-tachycardia pacing (ATP) episodes and defibrillator shocks was assessed as primary efficacy outcome. Treatment complications were assessed as primary safety outcome. Results: Overall, 25 patients underwent novel therapies for VAs, and 13 were excluded for insufficient follow up. Five, 4, and 3 patients underwent CSD, SBRT, and both, respectively. Median age was 66 years (55-72), and 10 (83%) were male. Median left ventricular ejection fraction was 30% (25%-34%). Four patients (33%) had ischemic cardiomyopathy. Median number of AADs and CA prior to novel therapies was 3 (2-5) and 1 (0-2), respectively. Follow up was available for a median of 12 (12-12) months before and 12 (9-12) months after treatment. Overall, VA burden was reduced in 11 of 12 patients (Figure 1). Mean number of ATP and shock episodes was significantly lower after novel therapies (39±43 vs 3±6; p= 0.008). No procedure-related complications were observed. Conclusion: Novel VA treatment modalities are associated with a significantly reduced arrhythmia burden in this single center study. There is a promising role of these therapies as an adjunct to the existing treatment modalities of CA and AADs.