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Incidence and Characteristics of Cervical Spine Injuries in Young Children Presenting to Community Emergency
Zaid S Alazawi1, Mahim Naveed2, Edward J Durant3
1Emergency Medicine Residency Program, Kaiser Permanente, Northern California, Modesto, California.
Insights
Cervical spine injuries (CSIs) are rare in young children visiting community emergency departments, with most cases having favorable outcomes. This low incidence emphasizes balancing diagnostic accuracy with reduced radiation exposure for these children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Radiology
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) developed a cervical spine injury (CSI) prediction rule for pediatric trauma centers.
- Epidemiology and clinical characteristics of CSI in young children presenting to community emergency departments (EDs) are not well-documented.
Purpose of the Study:
- To describe the incidence and clinical features of CSI in children aged 0-8 years presenting to community EDs.
- To evaluate the applicability of existing imaging recommendations in this population.
Main Methods:
- Retrospective chart review of ED encounters in children aged 0-8 years (2010-2024).
- Identification of potential CSI cases using diagnosis and procedure codes, confirmed by manual chart review.
- Assessment of PECARN imaging criteria presence.
Main Results:
- Traumatic CSI occurred in 9 out of 1,826,598 ED visits (1 per 202,955 visits).
- No patients required surgery or had neurological deficits at discharge.
- PECARN imaging criteria were met in all CSI cases; CT was suggested for 1 (11.1%) and radiography for 8 (88.9%).
Conclusions:
- CSI is exceedingly rare in young children presenting to community EDs, with generally favorable outcomes.
- The low prevalence underscores the need to balance diagnostic sensitivity with minimizing radiation exposure in neurologically intact children.
Objectives:
In 2024, the Pediatric Emergency Care Applied Research Network published a cervical spine injury (CSI) prediction rule derived from level 1 pediatric trauma centers. The epidemiology and clinical characteristics of CSI among young children presenting to community emergency departments (EDs) are less well described. We therefore sought to describe the baseline risk and clinical characteristics of CSI among young children presenting to community EDs and to provide context for the application of existing imaging recommendations in this setting.
Methods:
We conducted a retrospective chart review of ED encounters among children aged 0 to 8 years within Kaiser Permanente Northern California between January 1, 2010 and December 31, 2024. Diagnosis and procedure codes were used to identify potential CSI cases, which were confirmed by manual chart review. Clinical characteristics and outcomes were abstracted, and the presence of PECARN imaging criteria was assessed.
Results:
A total of 723,459 unique children aged 0 to 8 years accounted for 1,826,598 ED visits. Nine patients were diagnosed with traumatic CSI (1 per 202,955 visits). None required surgery or had neurological deficits at discharge. PECARN imaging criteria were present in all cases, with CT suggested in 1 patient (11.1%) and radiography in 8 (88.9%). In 2 cases, initial radiographs were normal, and injuries were subsequently identified on advanced imaging.
Conclusions:
CSI in young children presenting to community EDs was exceedingly rare and associated with favorable outcomes. The very low prevalence highlights the importance of balancing diagnostic sensitivity with minimization of radiation exposure in neurologically intact children.
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