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Cervical spine injuries in young children: pattern and outcomes in accidental versus inflicted trauma
Joanne Baerg1, Arul Thirumoorthi1, Rajaie Hazboun1
1Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda University, Loma Linda, California.
Insights
In children under 3, inflicted head trauma is linked to cervical spine injuries similar to accidental trauma. However, inflicted injuries often involve multisystem trauma and worse outcomes, with shaking as a common mechanism.
Area of Science:
- Pediatric Traumatology
- Neurology
- Orthopedic Surgery
Background:
- Head injuries in children under 3 years old can result from inflicted or accidental trauma.
- Cervical spine (c-spine) injuries are a concern in pediatric head trauma.
- Comparing injury patterns and outcomes is crucial for diagnosis and treatment.
Purpose of the Study:
- To compare the pattern and outcomes of cervical spine injuries in children under 3 years old with head injuries.
- To differentiate between inflicted and accidental trauma mechanisms in pediatric head and c-spine injuries.
Main Methods:
- Prospective data collection from July 2011 to January 2016.
- Inclusion criteria: age < 3 years, loss of consciousness, specific head CT findings.
- Utilized brain and neck MRI/MRA, comparing data via t-tests and Fisher exact tests.
Main Results:
- 73 children identified: 52 (71%) inflicted, 21 (29%) accidental trauma.
- 10% overall had c-spine injuries (7 inflicted, 3 accidental).
- Inflicted trauma group younger, with higher Injury Severity Scores, more subdural hematomas, fractures, retinal hemorrhages, brain infarcts, and CPR requirement.
Conclusions:
- Inflicted cervical spine injuries in young children are associated with multisystem trauma.
- Outcomes for inflicted c-spine injuries include higher rates of long-term disability from brain injury.
- The injury pattern in inflicted cases is consistent with shaking, differentiating it from accidental mechanisms.
Background:
The aim of the study was to compare the cervical spine (c-spine) pattern of injury and outcomes in children below 3 y with a head injury from confirmed inflicted versus accidental trauma.
Methods:
After Institutional Review Board approval, data were prospectively collected between July 2011 and January 2016. Inclusion criteria were age below 3 y, a loss of consciousness, and any one of the following initial head computed tomography (CT) findings (subdural hematoma, intraventricular, intraparenchymal, subarachnoid hemorrhage, or cerebral edema). A protocol of brain and neck magnetic resonance imaging and magnetic resonance angiography was instituted. Brain and neck imaging results, clinical variables, and outcomes were recorded. Data were compared by t-test for continuous and Fisher exact test for categorical variables.
Results:
73 children were identified, 52 (71%) with inflicted and 21 (29%) with accidental trauma. The median age was 11 mo; (range: 1-35 mo). Ten (14%) had c-spine injuries, 7/52 (13%) inflicted, and 3/21 (14%) accidental. The mechanism was shaking for all inflicted and motor vehicle accident or pedestrian struck for accidental c-spine injuries. The inflicted group were significantly younger (P = 0.03), had higher Injury Severity Scores (P = 0.02), subdural hematomas (P = 0.03), fractures (P = 0.03), retinal hemorrhages (P = 0.02), brain infarcts (P = 0.01), and required cardiopulmonary resuscitation (P = 0.01). Seven with inflicted trauma died from brain injury (9.5%), one had atlanto-occipital dissociation. Six mortalities (86%) had no c-spine injury. Six with inflicted c-spine injuries survived with neurologic impairment, whereas three with accidental survived without disability, including one atlanto-occipital dissociation.
Conclusions:
Compared to accidental trauma, young children with inflicted c-spine injuries have more multisystem trauma, long-term disability from brain injury, and an injury pattern consistent with shaking.
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