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Spine Injuries in Child Abuse
Julio J Jauregui1, Dean C Perfetti2, Frank S Cautela2
1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Journal of Pediatric Orthopedics
|September 24, 2016
Summary
Pediatric spine injuries are rare but more common in abused children, particularly those under two years old. Abuse is linked to longer hospital stays and higher costs for these severe spinal cord or vertebral column injuries.
Area of Science:
- Pediatric Traumatology
- Forensic Pediatrics
- Spinal Surgery
Background:
- Spinal injuries in children, though rare, can result from abuse and have severe consequences.
- This study investigates the characteristics and outcomes of pediatric spine injuries in abused versus non-abused children.
Purpose of the Study:
- To analyze the association between pediatric spine injury and abuse.
- To determine the affected spinal level, patient demographics, length of stay, and hospital charges in abused pediatric spine injury patients compared to non-abused patients.
Main Methods:
- Retrospective review of the Kids' Inpatient Database (2000-2012).
- Identification of pediatric patients (<18 years) with vertebral column fractures or spinal cord injuries using ICD-9-CM codes.
- Multivariate linear regression models adjusted for age, race, and sex.
Main Results:
- 0.5% of pediatric spine injury patients had a documented diagnosis of abuse, predominantly physical (75.9%).
- Abused patients were significantly younger (OR=133.4), more likely female, and nonwhite.
- Abused patients had increased risk of thoracic and lumbar fractures, longer hospital stays (62.2% increase), and higher hospital charges (52.9% increase).
- Children under 2 years with spine injuries were disproportionately represented in the abused cohort (19.7%).
Conclusions:
- Spine injuries in abused children are associated with younger age and the thoracolumbar region.
- These injuries lead to significantly longer hospitalizations and increased healthcare costs compared to non-abused children.
- Physicians should maintain a high index of suspicion for abuse in pediatric patients presenting with spine injuries, especially those under two years old.