Cervical spine injuries in pediatric trauma patients are uncommon, and subsequently, proper diagnosis and the efficacy of spinal motion restriction in these patients remain a subject of contention. The aim of this study was to describe the incidence of cervical spine injuries in pediatric patients in Iraq and Afghanistan.

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Introduction Traumatic brain injuries (TBIs) are life-threatening, and air transport of patients with TBI requires additional considerations. To mitigate the risks of complications associated with altitude, some patients fly with a cabin altitude restriction (CAR) to limit the altitude at which an aircraft’s cabin is maintained. The goal of this study was to examine the effects of CARs on patients with TBI transported out of theater via Critical Care Air Transport Teams. Materials and Methods We conducted a retrospective chart review of patients with moderate-to-severe TBI evacuated out of combat theater to Landstuhl Regional Medical Center via Critical Care Air Transport Teams. We collected demographics, flight and injury information, procedures, oxygenation, and outcomes (discharge disposition and hospital/ICU/ventilator days). We categorized patients as having a CAR if they had a documented CAR or maximum cabin altitude of 5,000 feet or lower in their Critical Care Air Transport Teams record. We calculated descriptive statistics and constructed regression models to evaluate the association between CAR and clinical outcomes. Results We reviewed the charts of 435 patients, 31% of which had a documented CAR. Nineteen percent of the sample had a PaO2 lower than 80 mm Hg, and 3% of patients experienced a SpO2 lower than 93% while in flight. When comparing preflight and in-flight events, we found that the percentage of patients who had a SpO2 of 93% or lower increased for the No CAR group, whereas the CAR group did not experience a significant change. However, flying without a CAR was not associated with discharge disposition, mortality, or hospital/ICU/ventilator days. Further, having a CAR was not associated with these outcomes after adjusting for additional flights, injury severity, injury type, or preflight head surgery. Conclusions Patients with TBI who flew with a CAR did not differ in clinical outcomes from those without a CAR.

Study Objectives: Moderate and severe traumatic brain injuries (TBI) are lifethreatening, necessitating prompt evaluation and intervention. The safe air transport of patients with TBI to a higher level of care requires additional considerations. Patients with TBI are susceptible to complications related to altitude, including hypobaria and hypoxia. To mitigate this risk, some patients are transported with a cabin altitude restriction (CAR), which limits the altitude at which an aircraft's cabin is maintained. The goal of this study was to examine the effects of altitude and oxygenation on patients with TBI transported via critical care air transport teams (CCATT) from a Role III medical treatment facility (MTF) to Landstuhl Regional Medical Center (LRMC).Methods: We conducted a retrospective chart review of patients with moderate to severe TBI evacuated out of combat theater via CCATT. Data abstractors collected data on demographics, flight information (including CAR), injury type, injury severity, pre-flight procedures, in-flight oxygenation, in-flight complications, and outcomes (mortality, hospital days, ICU days, and ventilator days). We calculated descriptive statistics and conducted Cox proportional hazards regression analyses to evaluate the association between CAR and clinical outcomes.Results: We reviewed the CCATT charts of 435 patients with TBI transported via CCATT from a Role III MTF to LRMC. Eighty-one patients (19%) had a recorded CAR. About 19% of the sample had a PaO2 lower than 80 mmHg and 5% of patients experienced an in-flight SpO2 of 93% or lower. Flying without a CAR was not significantly associated with increased mortality or more hospital days, ICU days, or ventilator days. Further, having a CAR was not significantly associated with hospital days, ICU days, or ventilator days after adjusting for additional flights, injury severity, and injury type.Conclusions: Patients with moderate or severe TBI who were flown with a recorded CAR did not significantly differ from those who flew without a CAR in mortality rates, hospital days, ICU days, or ventilator days.