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Pediatric Cervical Spine and Spinal Cord Injury: A National Database Study
John I Shin1, Nathan J Lee, Samuel K Cho
1From the Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Pediatric cervical spine injuries (PCSI) are rare but serious. While older children face higher risks, younger patients have a greater mortality rate from PCSI, highlighting age-related differences in outcomes.
Area of Science:
- Pediatric Traumatology
- Spinal Cord Injury Research
- Public Health Surveillance
Background:
- Pediatric cervical spine injury (PCSI) is a severe condition, yet comprehensive analysis is challenging due to its rarity and potential biases in previous database studies.
- Understanding PCSI trends and risk factors is crucial for improving patient outcomes and developing targeted prevention strategies.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of pediatric cervical spine injury (PCSI) using the large-scale Kids' Inpatient Database (KID).
- To identify independent risk factors for PCSI and associated mortality among pediatric trauma admissions.
Main Methods:
- A retrospective analysis of the triennial Kids' Inpatient Database (KID) from 2000 to 2012.
- Utilized International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify PCSI cases.
- Employed multivariate logistic regression to determine risk factors for PCSI and mortality, stratifying patients into five age groups.
Main Results:
- The prevalence of traumatic PCSI was 2.07% with a 4.87% mortality rate.
- Transportation accidents were the leading cause (57.51%).
- Older children had higher PCSI incidence, while younger children experienced higher mortality rates. Independent risk factors for PCSI included older age and transportation accidents; for mortality, younger age, transportation accidents, and specific injury types (upper cervical, dislocation, spinal cord injury) were significant.
Conclusions:
- Pediatric patients exhibit significant heterogeneity in PCSI risk and outcomes based on age.
- While older pediatric cohorts are more prone to PCSI, younger patients face a higher risk of mortality, underscoring the need for age-specific management and prevention approaches.
Study Design:
A retrospective administrative database analysis.
Objective:
The aim of this study was to investigate the incidence and characteristics of pediatric cervical spine injury (PCSI) utilizing the Kids' Inpatient Database (KID).
Summary Of Background Data:
PCSI is debilitating, but comprehensive analyses have been difficult due to its rarity. There have been a few database studies on PCSI; however, the studies employed databases that suffer from selection bias.
Methods:
The triennial KID was queried from years 2000 to 2012 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Pediatric admissions were divided into five age groups reflecting different developmental stages. PCSI was analyzed in terms of trend, demographics, injury characteristics, hospital characteristics, comorbidities, and outcomes variables. Multivariate logistic regression analyses were used to identify independent risk factors for PCSI among trauma admissions and to identify independent risk factors for mortality among PCSI admissions.
Results:
Over the past decade, the overall prevalence of traumatic PCSI was 2.07%, and the mortality rate was 4.87%. Most frequent cause of PCSI was transportation accidents, accounting for 57.51%. Upper cervical spine injury (C1-C4), cervical fracture with spinal cord injury, spinal cord injury without radiographic abnormality (SCIWORA), and dislocation showed a decreasing trend with age. Some comorbidities, including, but not limited to, fluid and electrolyte disorders, and paralysis were common across all age groups, while substance abuse showed a bimodal distribution. Independent risk factors for PCSI after trauma were older cohorts, non-Northeast region, and transportation accidents. For mortality after PCSI, independent risk factors were younger cohorts, transportation accidents, upper cervical spine injury, dislocation, and spinal cord injuries. Median length of stay and cost were 3.84 days and $14 742.
Conclusion:
Pediatric patients are highly heterogeneous, constantly undergoing behavioral, environmental, and anatomical changes. PCSI after trauma is more common among older cohorts; however, mortality after sustaining PCSI is higher among younger patients.
Level Of Evidence:
4.
