Pediatric Trauma Society

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Spine Injury in Cases of Suspected Abusive Trauma: An Alarming Phenomenon
Amelia C Lucisano, Christine M Leeper, *Barbara A Gaines
UPMC, Pittsburgh, PA

Background (issue): Abusive head trauma (AHT) is a major cause of morbidity and mortality in children, and has been associated with spine injuries on autopsy and MRI, though the clinical implications are poorly defined. We investigated the relationship between AHT and spine injuries in a cohort of children who were victims of child abuse.
Methods: We queried our Level I Pediatric Trauma Center database for patients age ≤ 3 with an injury mechanism of child abuse, who underwent screening or diagnostic spine MRI between 1/1/2005-12/31/2014. Demographics, injuries, and radiology results were collected. Primary outcome was a composite of mortality and functional disability at discharge. Fisher exact and Wilcoxon ranksum testing were performed.
Findings: 62 patients were included with median(IQR) age = 6 months (2-12), 45.2% female, median(IQR) injury severity score = 20.5 (15.5-27), and 38.7% poor outcome. 64.5% had a spine injury. Spine injury was associated with intracranial hemorrhage, hypoxic brain injury, retinal hemorrhages, and extremity fractures (P<0.05). Spine injury was also associated with longer length of stay and higher number of ICU days (P<0.05), with a trend toward poor outcome (P=0.064).
Conclusions (implications for practice): The incidence of spine injury in abused children is high, and is associated with AHT, particularly those with hypoxic brain injury and intracranial hemorrhage. Outcomes for patients with spinal injury are poor. Given these associations, we believe that spinal MRI should be obtained routinely in children with suspected AHT.

Factors associated with spine injury
Odds ratiop-value
Hypoxic brain injury4.130.023
Intra-cranial bleed8.670.049
Retinal hemorrhage5.830.006
Extremity fracture5.380.034
Poor outcome (death, rehab discharge, and/or feeding tube)3.070.064


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