Clearing the Pediatric Cervical Spine

Weber, Andreas D.; Nance, Michael L.

doi:10.1007/s40719-016-0059-6

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Unfortunately, one death occurred due to the traumatic injury in a young child who was struck by a vehicle while walking, representing a mortality rate of 2.5%. In comparison, the literature indicates that mortality rates of pediatric upper cervical spine trauma patients range from 16% to 18% [ 4 , 16 ]. New pediatric trauma protocols implemented by our center in the past 10 years might be a factor in our cohort’s lower mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, pediatric patients have a relatively larger head mass, resulting in a higher center of gravity and a greater propensity for high cervical spine injury rates following dynamic movements or sport [ 3 ]. Thus, this unique anatomy of the pediatric vertebral column poses a relatively increased risk for upper cervical spine injuries when compared to the adult spine [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Hasan¹,

Waheed²,

Suhrawardy³

et al. 2022

Cureus

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Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p <0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p =0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Hasan¹,

Waheed²,

Suhrawardy³

et al. 2022

Cureus

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“…ediatric cervical spine injury (CSI) following blunt trauma has an incidence of 0.6% to 2%. [1][2][3][4][5][6] For the youngest trauma patients, those younger than 3 years, clearance of the cervical spine may be difficult because patients can be nonverbal or nonparticipatory in the trauma evaluation.…”

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confidence: 99%

Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years

Luckhurst,

Wiberg,

Brown

et al. 2023

JAMA Surg

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ImportanceThere is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients.ObjectiveTo develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model.Design, Setting, and ParticipantsThis cohort study included pediatric patients (&lt;3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022.ExposureBlunt trauma.Main Outcomes and MeasuresPrimary outcome was CSI. The primary and secondary objectives were predetermined.ResultsThe current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models’ ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915).Conclusion and RelevanceThis study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.

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