Spine Trauma in Very Young Children: A Retrospective Study of 186 Patients Presenting to a Level 1 Pediatric Trauma Center

Knox, Jeffrey B.; Schneider, John E.; Cage, J. Matthew; Wimberly, Robert L.; Riccio, Anthony I.

doi:10.1016/j.spinee.2012.08.151

Cited by 17 publications

(44 citation statements)

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“…Mechanisms of spinal injury and anatomical patterns of injury have been described in many institutional case series and trauma registries, and the current study confirms these observations on a large scale. 1,6,[9][10][11][12]15,16,18,20,26,31,39,41,44,49,50 Notable are frequent associations with head and facial injury, high rates of injury at multiple levels of the spine, the predominance of high cervical injury in the youngest patients, and the relatively high rate of SCIWORA in that age group. Injuries of the thoracic and lumbosacral spine have received relatively scant attention in the literature, but in the cross-sectional survey reported here, these levels account for more than half of all injuries in every age group.…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids’ Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141–2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.

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Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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“…In that series, children younger than 3 years were more likely to present with devastating neurologic findings and to be injured in MVCs. 9 While the age-stratified models had inferior sensitivity to our original model, they may have been insufficiently powered to identify certain factors associated with CSI in the age-specific models. The large CIs around our point estimates of the model's sensitivity and specificity in children younger than 2 years suggests this limitation.…”

Section: Discussionmentioning

confidence: 94%

“…The benefit of age-stratified models for CSI, particularly for the very young, is also supported by the findings of other investigators. 5,9 In a retrospective, multicenter trauma registry review of children younger than 3 years old, four factors demonstrated 100% sensitivity and 70% specificity for CSI: age 2 up to 3 years, Glasgow Coma Scale (GCS) score of <14, GCS eye opening score of 1, and MVC injury mechanism. A recent single-center retrospective review of young children with spine injury supports these findings.…”

Section: Discussionmentioning

confidence: 99%

Age‐related Differences in Factors Associated With Cervical Spine Injuries in Children

Leonard

Jaffe

Olsen

et al. 2015

Academic Emergency Medicine

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Objectives: The Pediatric Emergency Care Applied Research Network (PECARN) investigators previously identified risk factors associated with cervical spine injuries (CSIs) in children. Anatomic maturation and age-related variation in mechanisms of injury suggested the need to explore factors separately for younger versus older children. The purpose of this substudy was to investigate CSI risk factors in age subgroups within the PECARN study cohort.Methods: This was an age-stratified case-control analysis of children younger than 16 years presenting to 17 PECARN hospitals following blunt trauma between January 1, 2000 and December 31, 2004. Data were abstracted for children with CSIs and randomly selected CSI-free children. Age-stratified multivariable logistic regression was performed to identify factors associated with CSI within three age groups: younger than 2, 2 to 7, and 8 to 15 years. Sensitivity and specificity for CSI were estimated for both the age-specific and original (altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash [MVC]) models.Results: Among 540 children with CSIs, 27 were younger than 2 years, 140 were 2 to 7 years, and 373 were 8 to 15 years. Focal neurologic deficits and high-risk MVC were associated with CSIs in all agespecific models. Other age-specific factors included the following: younger than 2 years, none; 2 to 7 years, altered mental status, neck pain, torticollis; and 8 to 15 years, altered mental status, neck pain, diving. Age-specific models had comparable sensitivity to the original model among the older groups, but had lower sensitivity and higher specificity among the youngest children.Conclusions: While this analysis supports the original PECARN model for CSI, there were subtle age variations in factors associated with CSIs in children that warrant future investigation.ACADEMIC EMERGENCY MEDICINE 2015;22:441-446

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“…Limited exposure to high-energy traumata may explain the very low incidence of atlas fractures in children. Different factors influence the flexibility of the growing spine, such as incompletely ossified and cartilaginous bones, laxity of intervertebral ligaments, underdeveloped neck musculature, an increased cranium to body weight ratio, and a higher fulcrum for cervical motion at C2–C3 15 16. Thus, the greater susceptibility to trauma in children reflects a different trauma mechanism of adults and children.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of fractured anterior arch of the atlas in a young child

Sesia¹,

Prüfer

Walther

et al. 2017

BMJ Case Reports

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A 2-year-old girl fell off a bunk bed onto a parquet floor. She immediately reported neck pain and presented with muscle spasm and limited motion of the cervical spine (C-spine). Plain X-rays of the C-spine showed no osseous lesion. Owing to persisting pain and limited motion in the neck, MRI of the C-spine was obtained which revealed intact ligaments and cervical spinal cord, as well as soft tissue swelling in front of the anterior arch of the atlas. Subsequent CT of the C-spine confirmed a complete, undisplaced fracture of the anterior arch of the atlas (Gehweiler type I fracture). A Minerva cast was applied for 2 months, followed by a soft cervical collar. Persistent neck pain and limited range of motion of the neck after a fall may be indicative of atlas fracture that should be ruled out by CT.

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Spine Trauma in Very Young Children: A Retrospective Study of 186 Patients Presenting to a Level 1 Pediatric Trauma Center

Cited by 17 publications

References 0 publications

Pediatric spinal injury in the US: epidemiology and disparities

Pediatric spinal injury in the US: epidemiology and disparities

Age‐related Differences in Factors Associated With Cervical Spine Injuries in Children

Delayed diagnosis of fractured anterior arch of the atlas in a young child

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