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Published on: July 24, 2012
Prevalence of cervical spine injury in infants with head trauma
Joel S Katz1, Chima O Oluigbo, C Corbett Wilkinson
1Department of Pediatric Neurosurgery, The Children's Hospital, University of Colorado, Aurora, Colorado 80045, USA.
Insights
Cervical spine injuries (CSIs) are rare in infants with head trauma, with only a 0.2% prevalence found. Nonaccidental trauma was the cause in the few cases identified, suggesting stricter imaging criteria for suspected abuse.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Cervical spine injuries (CSIs) in children vary by age and injury mechanism.
- Assessing CSI prevalence in infants with head trauma is crucial for appropriate diagnostic strategies.
Purpose of the Study:
- To determine the prevalence of cervical spine injuries (CSIs) in infants younger than 1 year who presented with head trauma.
Main Methods:
- Retrospective review of medical records for infants (<1 year) with head injuries from 1993-2007.
- Exclusion of injuries from motor vehicle accidents and falls >10 ft.
- Data collected included age, injury cause, diagnosis, disposition, outcome, and imaging/autopsy review.
Main Results:
- 905 infants with head trauma (mean age 4.3 months) were analyzed.
- Only 2 cases (0.2% prevalence) of CSI were identified.
- Both CSIs occurred in the context of nonaccidental trauma (NAT).
Conclusions:
- The prevalence of CSIs in infants with head trauma is very low (0.2%).
- Routine cervical spine imaging in this population has a low diagnostic yield.
- Stricter imaging criteria for infants with suspected nonaccidental trauma (NAT) are warranted due to the association with CSIs.
Object:
The incidence, type, and severity of pediatric cervical spine injuries (CSIs) are related to age and mechanism of injury. In this study, the authors assessed the prevalence of CSIs in infants with head trauma treated in their institution.
Methods:
The authors reviewed the medical records of children younger than 1 year of age who presented to The Children's Hospital with head injuries between January 1993 and December 2007. They excluded infants with head injuries resulting from motor vehicle accidents and known falls from heights greater than 10 ft. For each patient, collected data included age, cause of injury, diagnosis, discharge disposition, and outcome. Relevant imaging data were reviewed, and when appropriate, autopsy reports were also reviewed.
Results:
Nine hundred five infants with head trauma and without a major mechanism/cause were identified. Their mean age was 4.3 months. Of the 905 patients, only 2 cases of CSI were detected, giving a prevalence of 0.2%. The mechanism of injury in these 2 patients was nonaccidental trauma (NAT).
Conclusions:
The study revealed a very low prevalence of CSIs in infants with head trauma (0.2%). Routine cervical spine imaging in these infants, therefore, appears to have low diagnostic yield. The mechanism of head injury was NAT in the 2 patients who sustained an associated CSI. This supports the need for more stringent cervical spine imaging criteria for the infant with suspected NAT.
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