Hot Topic 3: Pediatric Cervical Spine Injuries
Review: (D. Hochstuhl) The purpose of this study was to determine the incidence and characteristics of cervical spine injuries in children less than age 5 at one institution. The study confirmed previous reports that show a very low incidence of cervical spine injury in this age group. The discussion is important as centers seek to decrease radiation and unnecessary CT scans in children.
J Trauma Acute Care Surg. 2015 May;78(5):943-8. doi: 10.1097/TA.0000000000000603.
Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger.
Hale DF1, Fitzpatrick CM, Doski JJ, Stewart RM, Mueller DL.
1From the San Antonio Military Medical Center, Fort Sam Houston, (D.F.H.); and University of Texas Health Science Center (J.J.D., R.M.S., D.J.M.), San Antonio, Texas; and Saint Louis University School of Medicine (C.M.F.), St. Louis, Missouri.
Increased accessibility and rapidity of computed tomography (CT) have led to increased use and radiation exposure to pediatric trauma patients. The thyroid is radiosensitive and therefore at risk for developing malignancy from radiation exposure during cervical spine CT. This analysis aimed to determine which pre-elementary trauma patients warrant cervical spine CT by defining incidence and clinical characteristics of pre-elementary cervical spine injury.
This was a retrospective review of pre-elementary trauma patients from 1998 to 2010 with cervical spine injury admitted to a Level I trauma center. Patients were identified from the trauma registry using DRG International Classification of Diseases-9th Rev. codes and reviewed for demographics, mechanism of injury, clinical presentation, injury location, injury type, treatment, and outcome.
A total of 2,972 pre-elementary trauma patients were identified. Twenty-two (0.74%) had confirmed cervical spine injuries. Eleven (50%) were boys, and the mean (SD) age was 3 (1.7) years. The most common mechanism of injury was motor vehicle collision (n = 16, 73%). The majority (59%) were in extremis, and 12 (55%) arrived intubated. The median Glasgow Coma Scale (GCS) score was 3 (interquartile range, 3-10); the median Injury Severity Score (ISS) was 33 (interquartile range, 17-56). Nineteen injuries (76%) were at the level of C4 level and higher. The mortality rate was 50%. All patients had clinical findings suggestive of or diagnostic for cervical spine injury; 18 (82%) had abnormal neurologic examination result, 2 (9%) had torticollis, and 2 (9%) had neck pain.
The incidence of cervical spine injury in pre-elementary patients was consistent with previous reports. Missing a cervical spine injury in asymptomatic pre-elementary patients is extremely low. Reserving cervical spine CT to symptomatic pre-elementary patients would decrease unnecessary radiation exposure to the thyroid.
LEVEL OF EVIDENCE:
Therapeutic study, level IV.
PMID: 25909413 [PubMed - indexed for MEDLINE]