181 Incidence of Cervical Spine Injury Among Pediatric Victims of Non-Accidental Trauma

• Published in: Neurosurgery Vol. 61; no. CN_suppl_1; pp. 219 - 220
• Main Authors: Melgar, Monica L., Russin, Jonathan, Bansal, Amy P., Krieger, Mark D.
• Format: Journal Article
• Language: English
• Published: Philadelphia Oxford University Press 01-08-2014; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Injuries; Neurosurgery; Pediatrics; Trauma
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/01.neu.0000452455.81043.82

Abstract
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 Institutional Review Board approved retrospective chart review of patients 0 to 4 years of age suspected of NAT from January 01, 1999 and January 06, 2010.
RESULTS:
One hundred forty-four patients were identified with a confirmed diagnosis of NAT based on mechanism and/or injury. Ninety-three (65%) were male; mean age was 8.6 months with a range of 0 to 42.5 months. Racial distribution was consistent with our catchment area. All 144 patients underwent skeletal surveys which included cervical spine imaging in 2-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. Thirty-five (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.
CONCLUSION:
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.