Evaluation of pediatric cervical spine injuries

doi:10.1016/S0735-6757(99)90111-0

The American Journal of Emergency Medicine

Volume 17, Issue 3, May 1999, Pages 230-234

https://doi.org/10.1016/S0735-6757(99)90111-0 Get rights and content

Abstract

To compare historical features, clinical examination findings, and radiographic results among pediatric patients with cervical spine injury (CSI), a retrospective review of patients who were diagnosed with CSI was undertaken. Two main groups were identified: radiographically evident cervical spine injury (RESCI), and spinal cord injury without radiographic abnormality (SCIWORA). Demographic, historical, clinical, and radiographic information was obtained from patients' charts and analyzed to determine factors associated with CSI and to determine the efficacy of the various radiographic views. Seventy-two children, ages from 1 month to 15 years (median age, 9 yrs), were included in the study. Sports-related injuries were the most common. Forty patients had RESCI and 32 had SCIWORA. Forty-nine (80%) of all the patients had abnormal findings on neck examination, and six (16%) of the RECSI group had abnormal neurological findings. Lateral radiographs had a sensitivity for CSI of 79%; a three-view radiographic series had a sensitivity of 94%. All patients with CSI who were clinically asymptomatic had both a high-risk injury mechanism and a distracting injury. CSI should be suspected in any child with abnormal findings on neck or neurological examination. A minimum of three radiographic cervical spine views should be obtained in the evaluation of CSI in children. Even in the face of a three-view series, CSI should be suspected in patients with an abnormal neck or neurological exam, high-risk mechanism of injury, or distracting injury.

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Citation Excerpt :
Such distinctions warrant independent assessments of pediatric spinal trauma outcomes. Cervical and thoracic spinal trauma, in particular, can be devastating in children, featuring high mortality and morbidity rates.9,12-15 However, risk factors of increased complications and hospital LOS following treatment of pediatric cervical/thoracic spinal trauma are relatively understudied.
This study aimed to investigate the impact of race on hospital length of stay (LOS) and hospital complications among pediatric patients with cervical/thoracic injury.
A retrospective cohort was performed using the 2017 admission year from 753 facilities utilizing the National Trauma Data Bank. All pediatric patients with cervical/thoracic spine injuries were identified using the ICD-10-CM diagnosis coding system. These patients were segregated by their race, non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian (NHA), and Hispanic (H). Demographic, hospital variable, hospital complications, and LOS data were collected. A linear and logistic multivariate regression analysis was performed to determine the risk ratio for hospital LOS as well as complication rate, respectively.
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Race may significantly impact health care resource utilization following pediatric cervical/thoracic spinal trauma.
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Children are particularly susceptible to craniocervical junction (CCJ) injury due to their disproportionate head-sizes, ligamentous laxity, and underdeveloped skeletal articulations.52 The younger the child, the more likely they are to undergo craniocervical injury, and beyond 10 to 12 years, a child’s likelihood of CCJ injury is equal to an adult’s.53,54 The most common cause of CCJ injury in young children is motor vehicle collision.55
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In the acute trauma setting, congenital absent cervical pedicle can be difficult to differentiate from unilateral facet dislocation and may require the use of advanced imaging and close communication between the neurosurgery and radiology departments. Given the high morbidity and mortality involved in the repair of facet dislocation in a child, it is crucial to maintain high degree of clinical suspicion for absent spinal pedicle. In this case, the patient nearly underwent surgical intervention, but was ultimately able to be discharged home with no symptoms or deficits after correct diagnosis.
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Traumatic spine injuries can be devastating for patients affected and for health care professionals if preventable neurological deterioration occurs. This review discusses the imaging options for the diagnosis of spinal trauma. It lays out when imaging is appropriate and when it is not. It discusses strength and weakness of available imaging modalities. Advanced techniques for spinal injury imaging will be explored. The review concludes with a review of imaging protocols adjusted to clinical circumstances.
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^☆: Presented at the American Pediatric Association, Western Regional Meeting, February 1996, Carmel, CA.

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Original contributionEvaluation of pediatric cervical spine injuries☆

Abstract

Ann Emerg Med

Am J Surg

Ann Emerg Med

J Emerg Med

Ann Emerg Med

J Pediatr Surg

Pediatric cervical spine fractures: predominantly subtle presentation

J Pediatr Surg

Selective application of cervical spine radiography in alert victims of blunt trauma: A prospective study

J Trauma

Prospective analysis of acute cervical spine injury: A methodology to predict injury

Ann Emerg Med

Reliability of indications for cervical spine films in trauma patients

J Trauma

Original contribution
Evaluation of pediatric cervical spine injuries☆