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Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern
Joanne Baerg1, Arul Thirumoorthi1, Rosemary Vannix1
1Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.
Insights
Cervical spine (c-spine) injuries occur in 15.1% of young children with inflicted trauma. Associated factors include retinal hemorrhages and lower Glasgow coma score (GCS), necessitating c-spine imaging in shaken infants.
Area of Science:
- Pediatric Traumatology
- Child Abuse and Neglect
- Radiology
Background:
- Inflicted trauma in young children can result in severe injuries.
- Cervical spine (c-spine) injuries are a critical concern in pediatric trauma.
- Early identification and characterization of c-spine injuries are vital for patient outcomes.
Purpose of the Study:
- To determine the incidence and patterns of cervical spine (c-spine) injuries in children under 36 months with inflicted trauma.
- To identify associated clinical and imaging findings with c-spine injuries in this population.
Main Methods:
- A prospective cohort study included 53 children under 36 months with inflicted trauma and specific head CT findings.
- Brain and neck MRI/MRA were performed within 48 hours.
- Statistical analysis compared variables using t-tests and Fisher-exact tests.
Main Results:
- Cervical spine (c-spine) injury was identified in 15.1% of the children.
- Injury patterns included ligamentous injury, vertebral artery shear injury, atlantooccipital dissociation (AOD), and cord/epidural hematomas.
- Retinal hemorrhages, shaking, lower Glasgow coma score (GCS), and brain injuries were associated with c-spine injury.
Conclusions:
- The incidence of cervical spine (c-spine) injury in young children with inflicted trauma is 15.1%.
- The injury pattern is diverse and associated with specific clinical indicators.
- C-spine imaging is recommended for shaken infants with suspected inflicted trauma.
Aim:
The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36months with inflicted trauma.
Methods:
An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48h. Variables were compared by t-test and Fisher-exact test.
Results:
There were 53 children (median age: five months; range: 1-35months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p=0.02), shaking (p=0.04), lower Glasgow coma score (GCS) (p=0.01), brain infarcts (p=0.01), and hypoxic/ischemic injury (p=0.01) were associated with c-spine injury. One with AOD died. Six had significant disability.
Conclusion:
For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging.
Level Of Evidence:
Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis.
