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Published on: March 27, 2016
Pediatric spinal injury: review of 61 deaths
1Department of Clinical Neurosciences, University of Calgary, Alberta, Canada.
Insights
Pediatric spinal cord injuries are rare but deadly, with most children dying at the scene. Improved treatment strategies offer little hope for better outcomes in severe pediatric spinal trauma.
Area of Science:
- Traumatology
- Pediatric Surgery
- Neurology
Background:
- Spinal column and spinal cord injuries are infrequent in children.
- Pediatric spinal injury mortality is disproportionately high compared to adults.
Purpose of the Study:
- To review pediatric deaths associated with spinal injury.
- To analyze the characteristics and causes of mortality in pediatric spinal trauma.
Main Methods:
- Retrospective review of 61 pediatric deaths with spinal injury.
- Analysis of autopsy findings, including Abbreviated Injury Scale (AIS) scores.
- Comparison with adult spinal injury mortality data.
Main Results:
- Pediatric spinal injuries accounted for 28% of spine-injured and 45% of spinal cord-injured pediatric cases studied.
- The pediatric to adult spinal injury mortality ratio was 2.5:1.
- 89% of pediatric deaths occurred at the accident scene; 19 had AIS Grade 6 injuries.
- Spinal cord injury caused death in only 8 children, often linked to high cervical cord injury and cardiorespiratory arrest in severe multiple trauma cases.
Conclusions:
- Severe pediatric spinal trauma, particularly with high cervical cord involvement, has a grim prognosis.
- Current treatment strategies offer limited potential for improving outcomes in this severely injured pediatric population.
Abstract:
Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. The authors present a unique review of 61 pediatric deaths associated with spinal injury. This group represented 28% of the total pediatric spine-injured population and 45% of the total pediatric spinal cord-injured group studied. The ratio of pediatric to adult spinal injury mortality was 2.5:1. Of the 61 children, 54 (89%) died at the accident scene. Thirty patients underwent a complete autopsy, 19 of whom had an Abbreviated Injury Scale Grade 6 injury (maximum score, untreatable). Spinal cord injury was found to be the cause of death in only eight children and was associated with injury to the high cervical cord and cardiorespiratory arrest. These children typically sustained severe multiple trauma. In this population, there appears to be little room for improved outcome through changes in treatment strategy.
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