Traumatic Fracture of the Pediatric Cervical Spine: Etiology, Epidemiology, Concurrent Injuries, and an Analysis of Perioperative Outcomes Using the Kids' Inpatient Database

Abstract

Background: The study aimed to characterize trends in incidence, etiology, fracture types, surgical procedures, complications, and concurrent injuries associated with traumatic pediatric cervical fracture using a nationwide database. Methods: The Kids' Inpatient Database (KID) was queried. Trauma cases from 2003 to 2012 were identified, and cervical fracture patients were isolated. Demographics, etiologies, fracture levels, procedures, complications, and concurrent injuries were assessed. The t-tests elucidated significance for continuous variables, and v 2 for categoric values. Logistic regressions identified predictors of spinal cord injury (SCI), surgery, any complication, and mortality. Level of significance was P , .05. Results: A total of 11 196 fracture patients were isolated (age, 16.63 years; male, 65.7%; white, 65.4%; adolescent, 55.4%). Incidence significantly increased since 2003 (2003 vs 2012, 2.39% vs 3.12%, respectively), as did Charlson Comorbidity Index (CCI; 2003 vs 2012, 0.2012 vs 0.4408, respectively). Most common etiology was motor vehicle accidents (50.5%). Infants and children frequently fractured at C2 (closed: 43.1%, 32.9%); adolescents and young adults frequently fractured at C7 (closed: 23.9%, 26.5%). Upper cervical SCI was less common (5.8%) than lower cervical SCI (10.9%). Lower cervical unspecified-SCI, anterior cord syndrome, and other specified SCIs significantly decreased since 2003. Complications were common (acute respiratory distress syndrome, 7.8%; anemia, 6.7%; shock, 3.0%; and mortality, 4.2%), with bowel complications, cauda equina, anemia, and shock rates significantly increasing since 2003. Concurrent injuries were common (15.2% ribs; 14.4% skull; 7.1% pelvis) and have significantly increased since 2003. Predictors of SCI included sports injury and CCI. Predictors of surgery included falls, sports injuries, CCI, length of stay, and SCI. CCI, SCIs, and concurrent injuries were predictors of any complication and mortality, all (P , .001). Conclusions: Since 2003, incidence, complications, concurrent injuries, and fusions have increased. CCI, SCI, falls, and sports injuries were significant predictors of surgical intervention. Decreased mortality and SCI rates may indicate improving emergency medical services and management guidelines. Level of Evidence: III Clinical Relevance: Clinicians should be aware of increased case complexity in the onset of added perioperative complications and concurrent injuries. Cervical fractures resultant of sports injuries should be scrutinized for concurrent SCIs.

Spine Fractures in Children and Adolescents—Frequency, Causes, Diagnostics, Therapy and Outcome—A STROBE-Compliant Retrospective Study at a Level 1 Trauma Centre in Central Europe

“…Accordingly, a higher frequency of cervical spine fractures was noted in adolescents. These findings are comparable to Poorman et al and Shin et al, but are contrary to the findings of Compagnon et al and Mahan et al, who reported a tendency of cervical spine injuries in younger children [ 18 , 21 , 22 , 23 ]. This discrepancy may be explained by differences in the study population and inclusion criteria.…”

“…This discrepancy may be explained by differences in the study population and inclusion criteria. Poorman et al only referred to cervical spine fractures in their study reporting a higher prevalence of cervical spine fractures in adolescents (ages 11–18 years) and young adults (ages 19–20 years) [ 21 ]. The inclusion criteria of Compagnon et al and Mahan et al contained not only vertebral fractures, but also ligamentous injuries of the paediatric cervical spine [ 18 , 23 ].…”

Morbidity after traumatic spinal injury in pediatric and adolescent sports-related trauma

“…Many studies have found associations with cervical spine injuries in pediatric patients younger than 2 years of age. 26,31,34,36,38 This finding is in part attributable to the higher fulcrum, larger head, and unfused synchondroses commonly at the site of the dens in younger children. 4 As children get older and their cervical spines stabilize, it becomes more common to see thoracolumbar injuries as they become adolescents and adults.…”

Cytokine Profile as a Marker of Cell Damage and Immune Dysfunction after Spinal Cord Injury

“…High mortality rates (ranging between 16% and 18%) are reported for children. Frequently they are associated with a trauma of the cervical spine, especially its upper portion [13][14][15][16]. The leading causes of death comprise respiratory problems, cardiovascular disorders, thromboembolic events, infectious complications, and suicides [17].…”