Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 9, September 2011, Pages 1771-1776
Journal of Pediatric Surgery

Original article
Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review

https://doi.org/10.1016/j.jpedsurg.2011.03.007Get rights and content

Abstract

Background

The objective of this study was to characterize the incidence, risk factors, and patterns of cervical spine injury (CSI) in different pediatric developmental ages.

Methods

A retrospective review of the National Trauma Data Bank was conducted for the period of January 2002 through December 2006 to identify pediatric patients admitted following blunt trauma. Patients were stratified into 4 developmental age groups: infants/toddlers (age 0-3 years), preschool/young children (age 4-9 years), preadolescents (age 10-13 years), and adolescents (age 14-17 years). Patients with a CSI were identified by the International Classification of Diseases, Ninth Revision codes. Demographics, clinical injury data, level of CSI, and outcomes were abstracted and analyzed.

Results

A total of 240,647 patients met the inclusion criteria. Of these, 1.3% (n = 3,035) sustained a CSI. The incidence of CSI in the stratified age groups was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents. The level of CSI (upper [C1-C4] vs lower [C5-C7]) according to the age groups was as follows: infants and toddlers, 70% vs 25%; preschool/young children, 74% vs 17%; preadolescents, 52% vs 37%; and adolescents, 40% vs 45%, respectively. The adjusted risk for CSI increased 2-fold in preadolescents and 5-fold in adolescents.

Conclusion

The incidence of pediatric CSI increases in a stepwise fashion after 9 years of age. We noted an increase in lower CSI and a decrease in upper CSI after the age of 9 years. The incidence of upper CSI compared with lower CSI was higher in preadolescents (52% vs 37%) and almost equal in adolescents (40% vs 45%).

Section snippets

Background

About 1% to 2% of pediatric patients requiring hospital admission after blunt trauma sustain a cervical spine injury (CSI) [1], [2], [3], [4], [5], [6]. Although this incidence is relatively low, CSI constitutes 60% to 80% of all pediatric spinal injuries [2]. Anatomical differences between pediatric and adult cervical spine are prominent until approximately 9 years of age [2], [7], [8]. Hence, previous reports have stratified pediatric patients with CSI into 2 groups: those 9 years or younger,

Methods

A retrospective review of the NTDB Version 7.0 was conducted for the period of January 2002 through December 2006 to identify pediatric patients (age <18 years) admitted for blunt injury. The NTDB is a trauma registry with participation of more than 600 trauma centers in the United States and maintains in excess of 2 million prospectively collected medical records. All data provided by NTDB are deidentified and subjected to quality screening for consistency and validity by the American College

Results

Of a total of 322,475 pediatric patients in the NTDB, 87% (n = 240,674) met the study inclusion criteria. Overall, 64% were male, 18% had ISS of at least 16, 3% were hypotensive on admission, 7% had GCS ≤ 8, 37% suffered falls, and 46% were injured in motor vehicle accidents (MVAs).

A comparison of the demographics and clinical characteristics by the 4 age groups is depicted in Table 1.

The overall CSI rate was 1.3% (95% CI, 1.22-1.31). The incidence of CSI was 0.4% (95% CI, 0.3-0.5) in

Discussion

The differences in incidence and injury patterns of CSI between children and adults have been established. The etiology of these discrepancies has been postulated to rely on anatomical and behavioral diversities [10]. Anatomical differences between adult and pediatric cervical spine are manifold; in children, the head is disproportionately larger, and the neck musculature is relatively underdeveloped. The vertebral bodies are wedge shaped and incompletely ossified, the articulating facets are

References (12)

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