U.S. Estimates of Pediatric Spinal Cord Injury: Implications for Clinical Care and Research Planning
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Published on: August 17, 2013
Jaspreet K Dhillon1, Junxin Shi2, Alyssa Janezic2
11 The Ohio State University College of Medicine , Columbus, Ohio.
Insights
Accurate estimates show that only a small fraction of children with spinal cord injuries (SCIs) meet clinical trial criteria. These eligible pediatric SCI patients are concentrated in the South, often treated at non-pediatric centers.
Area of Science:
- Pediatric Traumatology
- Epidemiology of Spinal Cord Injury
- Clinical Trial Eligibility
Background:
- Spinal cord injuries (SCIs) in children are a significant public health concern.
- Characterizing the pediatric SCI population is crucial for advancing research and clinical care.
- Identifying children eligible for clinical trials is essential for therapeutic development.
Purpose of the Study:
- To provide accurate national estimates of children with spinal cord injuries (SCIs).
- To identify and characterize the subset of pediatric SCI patients eligible for clinical trials.
- To inform resource allocation for pediatric SCI research and care.
Main Methods:
- Utilized the Kids' Inpatient Database (2006, 2009, 2012) to identify children (<18 years) with SCI International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
- Applied exclusion criteria (late effects, transfers, unspecified levels, short stays) to refine the SCI cohort.
- Employed conventional rationale to determine clinical trial eligibility for pediatric SCI cases.
Main Results:
- Over three years, 2,484 children had SCI ICD-9-CM codes; 1,342 had true SCI, and 706 met clinical trial criteria.
- National estimates indicate 2,013 children with SCI and 1,062 eligible for trials.
- Eligible pediatric SCI patients were predominantly in the cervical region (66.1%), male (65.5%), older (51.1% aged 16-17), and located in the South (49.8%).
- Most were treated at urban teaching hospitals (84.6%), with only 20.3% at pediatric centers; 66.3% of hospitals treated only one child with SCI over three years.
Conclusions:
- Children eligible for SCI clinical trials represent less than one-third of those with SCI ICD-9-CM codes.
- These children are regionally concentrated and infrequently treated at specialized pediatric centers.
- Findings underscore the need for strategic resource allocation to optimize pediatric SCI clinical care and research outcomes.
Abstract:
The aim of this study was to provide accurate estimates and characterizations of children with spinal cord injuries (SCIs) and for the subset that are appropriate for inclusion in clinical trials. We identified children <18 years of age with SCI International Classifications of Diseases, Ninth Revision, Clinical Modification Codes (ICD-9-CM codes) from the 2006, 2009, and 2012 Kids' Inpatient Database. We excluded those with late effects, transfers to other hospitals, unspecified injury levels, and hospital stays <48 h. We then used conventional rationale to identify children who were eligible for SCI clinical trials. Over 3 years, 2484 children had SCI ICD-9-CM codes; 1342 had coding consistent with true SCI and 706 satisfied clinical trial inclusion criteria, yielding national estimates of 2013 and 1062, respectively. Of children with clinical trial eligible SCI, injuries were more common in the cervical region (66.1%), males (65.5%), older children (51.1% were 16-17 years old), and the South (49.8%). The majority were treated at urban teaching hospitals (84.6%); however, only 20.3% were treated at pediatric-specific centers. Of the 445 sample hospitals treating children with SCI, 66.3% treated just 1 child in the 3-year period. Children eligible for SCI clinical trials represented less than one third of children with SCI ICD-9-CM codes. These children were regionally localized to the South, with few receiving treatment at pediatric-specific centers or centers that frequently care for children with SCI. These findings highlight the importance of carefully assessing the national distribution of children with SCI, so that resources are appropriately allocated to optimize clinical care and research outcomes.
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