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Abnormal Spine Imaging Is Associated With Abusive Head Trauma: A Retrospective Case Control Study
Amelia C Lucisano1, *Barbara A Gaines2, Stephen J Strotmeyer2
1University of Pittsburgh Medical Center, Pittsburgh, PA;2UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA

Background (issue): Spine injury may occur in patients with abusive head trauma (AHT) with greater frequency than previously suspected. We investigated the potential association of spine injury with AHT compared to accidental injury.
Methods: Patients from our Level 1 pediatric trauma center, age ≤ 3, who underwent spine magnetic resonance imaging (MRI) between 1/1/2005 and 12/13/2014, were selected. Cases sustained AHT (N=62) while controls had accidental injury (N=66). Demographic, injury, and radiology findings were collected. Primary outcome was a composite of mortality and functional disability at discharge. Statistical analyses included Wilcoxon ranksum, Chi-square, Fisher's exact, and logistic regression.
Findings: The AHT group, compared to the accidental injury group, was younger (median age 5.5 months (IQR 2-12) vs. 24 (12-36), p<0.0001) and had a higher injury severity score (ISS) (median ISS 20.5 (14-27) vs. 13.5 (4-25), P=0.0001). While the primary outcome did not differ between groups, the AHT group was more likely to have an abnormal spine MRI (OR 2.05, p=0.046). After controlling for other covariates, an abnormal spine MRI is likely independently associated with an injury mechanism of abuse (Table 1).
Conclusions (implications for practice): Abnormal spine imaging appears to be associated with pediatric AHT. The finding of an abnormal spine MRI in a child with a head injury of unclear etiology should raise the suspicion for possible AHT.

Regression Model for Independent Predictors of Abuse
Adjusted Odds Ratio95% Confidence Intervalp value
Abnormal Spine Imaging2.280.896-5.800.084
Admit GCS1.090.985-1.200.095

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