Introduction: Incidence of cervical spine injury in cases of childhood non-accidental trauma (NAT) is unknown. To help guide the evaluation of children suspected of NAT, we examined our database to determine the incidence of cervical spine injury in these patients.
Methods: A single-center IRB approved retrospective chart review of patients 0-4 years of age suspected of NAT from 1/1/1999 and 6/1/2010.
Results: 144 patients were identified with a confirmed diagnosis of NAT based on mechanism and/or injury. 93 (65%) were male; mean age was 8.6 months with a range of 0-42.5 months. Racial distribution was consistent with our catchment area. All 144 patients underwent skeletal surveys which included cervical spine imaging in two-dimension, 9 had cervical spine computed tomography (CT) scans and 7 had magnetic resonance (MR) scans. Both clinically and radiologically, none of these children were found to have cervical spine injuries. 35 (24%) sustained a skull fracture, 11 (8%) sustained intra-axial hemorrhage and 71 (49%) sustained extra-axial hemorrhage. Reasons for presentation included falls (35), children found down (21), seizure activity (18), swelling (29) and irritability (29). 10% of patients were unresponsive or unconscious on arrival. Over a mean follow-up period of 17 months, patients were not found to have any evidence of cervical spine injury.
Conclusions: Out of a large hospital database, no victims of NAT were found to have cervical spine injuries. Clinicians may consider the need for cervical spine imaging on a case-by-case basis.
Patient Care: Our study looks at improving the evaluation of cervical spine injuries in cases of pediatric NAT. There was no clinical benefit found with regards to additional cervical spine imaging, suggesting that eliminating cervical spine MRIs and CT scans in this subset of patients may not only reduce unnecessary cost without compromising patient care, but also reduce the risk that these children are exposed to in the way of radiation exposure and potential complications of general anesthesia.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) State the incidence of cervical spine injury in children with NAT and 2) Understand the risks and benefits of cervical spine imaging in pediatric NAT.
References: Hadley M N, Zabramski J M, Browner C M, Rekate H, Sonntag K H. Pediatric spinal trauma: review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 1988; 68: 18–24.
Dickman C, A, Rekate H, L, Sonntag V, K, H, Zabramski J, M, Pediatric Spinal Trauma: Vertebral Column and Spinal Cord Injuries in Children. Pediatr Neurosurg 1989;15:237-256
Katz JS, Oluigbo CO, Wilkinson CC, et al. Prevalence of cervical spine injury in infants with head trauma. J Neurosurg Pediatr 2010; 5(5): 470-73.