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Cervical spine injuries in children.
D Bohn1, D Armstrong, L Becker
1Department of Pediatrics and Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
The Journal of Trauma
|April 1, 1990
Summary
High cervical spine injuries in children can cause cardiorespiratory arrest or hypotension, even without clear X-ray findings. This previously unrecognized cause of sudden death in pediatric trauma requires consideration in emergency evaluations.
Area of Science:
- Pediatric Traumatology
- Neurology
- Emergency Medicine
Background:
- Cardiorespiratory arrest post-trauma is typically attributed to cerebral injury, hemorrhage, or airway issues.
- A specific subgroup of pediatric trauma patients presents with unexplained absent vital signs or hypotension.
Purpose of the Study:
- To identify and characterize a distinct pattern of high cervical spine and cord injury in children presenting with cardiorespiratory arrest or severe hypotension.
- To highlight this previously unrecognized cause of pediatric cardiorespiratory arrest.
Main Methods:
- Retrospective review of 19 pediatric patients (mean age 6.3 years) with cardiorespiratory arrest/hypotension post-trauma.
- Analysis of radiologic (X-ray) and postmortem findings to identify cervical spine and cord injuries.
Main Results:
- 14 patients had injuries to the high cervical spine (C1-C3); 2 had lower cervical spine (C6-7) injuries, and 2 had normal cervical spine X-rays.
- 13 of 16 patients with postmortem examinations showed cord laceration or transection.
- 18 of 19 children were resuscitated but died from hypoxic/ischemic encephalopathy and cerebral injury.
Conclusions:
- A unique pattern of "juvenile" cervical spine injury involving the high spine and cord can lead to apnea, cardiorespiratory arrest, or severe hypotension.
- This diagnosis should be considered in pediatric trauma patients with absent vital signs, even with normal cervical spine imaging.