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Published on: January 5, 2015
Patterns and risks in spinal trauma
B W Martin1, E Dykes, F E Lecky
1Salford Royal Hospitals NHS Trust, UK. bruce.martin@virgin.net
Insights
Pediatric spinal cord injury (SCI) and spinal cord injury without radiological abnormality (SCIWORA) are more common in children under 8. Associated chest and head injuries, along with a reduced Glasgow Coma Scale (GCS) score, increase the risk of SCI.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Orthopedic Surgery
Background:
- Spinal injuries in children are infrequent but present significant management challenges.
- Understanding the epidemiology of pediatric spinal trauma is crucial for effective clinical practice.
Purpose of the Study:
- To determine the prevalence of spinal injuries in the pediatric trauma population.
- To evaluate the risk factors associated with spinal cord injury, including age, level of consciousness, injury severity, and concomitant injuries.
Main Methods:
- Data were extracted from the UK Trauma Audit & Research Network Database (1989-2000).
- Relative risks of spinal injury were calculated using the pediatric trauma population as the denominator.
Main Results:
- Spinal column fracture/dislocation without cord injury occurred in 2.7% of pediatric trauma patients.
- Cord injury was identified in 0.56% of all children, and spinal cord injury without radiological abnormality (SCIWORA) in 0.15%.
- Younger children (age ≤8) had a higher incidence of cord injury and SCIWORA. Increased Injury Severity Score (ISS >25) and chest injuries correlated with fracture/dislocation risk, while reduced GCS and head injuries increased cord injury risk.
Conclusions:
- Spinal cord injury and SCIWORA are more prevalent in younger children.
- Multiple injuries, particularly chest and head trauma, elevate the risk of spinal fractures and cord injuries.
- A reduced Glasgow Coma Scale (GCS) score is a significant indicator for increased risk of cord injury.
Background:
Spinal injury in children is rare, and poses many difficulties in management.
Aims:
To ascertain the prevalence of spinal injury within the paediatric trauma population, and to assess relative risks of spinal injury according to age, conscious level, injury severity score (ISS), and associated injuries.
Methods:
Spine injured children were identified from the UK Trauma Audit & Research Network Database from 1989 to 2000. Relative risks of injury were calculated against the denominator paediatric trauma population.
Results:
Of 19 538 on the database, 527 (2.7%) suffered spinal column fracture/dislocation without cord injury and 109 had cord injury (0.56% of all children; 16.5% of spine injured children). Thirty children (0.15% of all children; 4.5% of spine injured children) sustained spinal cord injury without radiological abnormality (SCIWORA). Cord injury and SCIWORA occurred more commonly in children aged < or =8. The risk of spine fracture/dislocation without cord injury was increased with an ISS >25 and with chest injuries. The risk of cord injury was increased with reduced GCS, head injury, and chest injury.
Conclusions:
Spinal cord injury and SCIWORA occur more frequently in young children. Multiple injuries and chest injuries increase the risk of fracture/dislocation and of cord injury. Reduced GCS and head injuries increase the risk of cord injury.
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