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Predictors of clinically significant underlying etiologies in children presenting with torticollis
Matan Shemer1,2, Shai Noyman2, Ayelet Rimon2,3
1Department of Pediatric, Dana Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
One in six children presenting with torticollis to the paediatric emergency department had a serious underlying condition. This highlights the need for a structured, symptom-guided diagnostic approach in pediatric torticollis cases.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Neurology
- Musculoskeletal Disorders
Background:
- Torticollis is a frequent reason for pediatric emergency department visits.
- While often benign, torticollis can indicate serious underlying pathology.
- Prompt diagnosis is crucial for effective management.
Purpose of the Study:
- To determine the incidence of clinically significant diagnoses in children presenting with torticollis.
- To identify key indicators associated with serious underlying conditions in pediatric torticollis.
Main Methods:
- Retrospective review of children under 18 years old presenting with torticollis.
- Data collected from 2018-2023 at Tel Aviv Sourasky Medical Center.
- Primary outcome: identification of infectious etiology, tumors, or atlantoaxial rotatory fixation (AARF).
Main Results:
- 17% of 352 children had a significant diagnosis: infectious causes (59%), AARF (30%), and tumors (10%).
- Infectious cases were younger, febrile, with elevated C-reactive protein.
- AARF associated with older age, prolonged symptoms, midline tenderness, and restricted motion.
Conclusions:
- Approximately 17% of pediatric torticollis cases involve serious underlying conditions.
- A structured, symptom-guided diagnostic approach is essential for pediatric torticollis.
- Early identification of red flags aids in timely intervention for critical conditions.
Background:
Torticollis is a common presentation in paediatric emergency departments (PEDs), usually benign but sometimes the first sign of serious pathology.
Methods:
We retrospectively reviewed children <18 years presenting with torticollis to the PED at Tel Aviv Sourasky Medical Center (2018 through 2023). The primary outcome was a clinically significant underlying condition: (1) infectious aetiology, (2) head, neck, or cervical spine tumour or (3) atlantoaxial rotatory fixation (AARF) requiring intervention.
Results:
Among 352 children (median age 4.8 years; 52% male), 59 (17%) had a clinically significant diagnosis: infectious causes (35/59 [59%]), AARF (18/59 [30%]) and tumours (6/59 [10%]). Infectious cases were younger (P = 0.03), more likely to be febrile (P < 0.001), and had higher C-reactive protein levels (P < 0.001). AARF was associated with older age (P = 0.002), prolonged symptoms (P < 0.001), midline tenderness (P = 0.002) and restricted motion (P < 0.001).
Conclusion:
One in six children with torticollis had a serious underlying condition, supporting a structured, symptom-guided diagnostic approach.
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