Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern

Joanne Baerg, Arul Thirumoorthi, Rosemary Vannix, Asma Taha, Amy Young, Alexander Zouros

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Aim: The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36. months with inflicted trauma. Methods: An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36. months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48. h. Variables were compared by t-test and Fisher-exact test. Results: There were 53 children (median age: five months; range: 1-35. months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p = 0.02), shaking (p = 0.04), lower Glasgow coma score (GCS) (p = 0.01), brain infarcts (p = 0.01), and hypoxic/ischemic injury (p = 0.01) were associated with c-spine injury. One with AOD died. Six had significant disability. Conclusion: For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging. Level of evidence: Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
Publication statusAccepted/In press - Jan 3 2017
Externally publishedYes

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Keywords

  • Cervical spine injury
  • Inflicted trauma
  • Pattern of injury
  • Shaken infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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