Pediatric Cervical Spine and Spinal Cord Injury: A National Database Study

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Abstract

Study Design.

A retrospective administrative database analysis.

Objective.

The aim of this study was to investigate the incidence and characteristics of pediatric cervical spine injury (PCSI) utilizing the Kids’ Inpatient Database (KID).

Summary of Background Data.

PCSI is debilitating, but comprehensive analyses have been difficult due to its rarity. There have been a few database studies on PCSI; however, the studies employed databases that suffer from selection bias.

Methods.

The triennial KID was queried from years 2000 to 2012 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Pediatric admissions were divided into five age groups reflecting different developmental stages. PCSI was analyzed in terms of trend, demographics, injury characteristics, hospital characteristics, comorbidities, and outcomes variables. Multivariate logistic regression analyses were used to identify independent risk factors for PCSI among trauma admissions and to identify independent risk factors for mortality among PCSI admissions.

Results.

Over the past decade, the overall prevalence of traumatic PCSI was 2.07%, and the mortality rate was 4.87%. Most frequent cause of PCSI was transportation accidents, accounting for 57.51%. Upper cervical spine injury (C1–C4), cervical fracture with spinal cord injury, spinal cord injury without radiographic abnormality (SCIWORA), and dislocation showed a decreasing trend with age. Some comorbidities, including, but not limited to, fluid and electrolyte disorders, and paralysis were common across all age groups, while substance abuse showed a bimodal distribution. Independent risk factors for PCSI after trauma were older cohorts, non-Northeast region, and transportation accidents. For mortality after PCSI, independent risk factors were younger cohorts, transportation accidents, upper cervical spine injury, dislocation, and spinal cord injuries. Median length of stay and cost were 3.84 days and $14 742.

Conclusion.

Pediatric patients are highly heterogeneous, constantly undergoing behavioral, environmental, and anatomical changes. PCSI after trauma is more common among older cohorts; however, mortality after sustaining PCSI is higher among younger patients.

Conclusion.

Level of Evidence: 4

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