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

3 Citations (Scopus)

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
StateAccepted/In press - Jan 3 2017
Externally publishedYes

Fingerprint

Spine
Wounds and Injuries
Dissociative Disorders
Retinal Hemorrhage
Coma
Hematoma
Cohort Studies
Diffuse Axonal Injury
Prospective Studies
Unconsciousness
Vertebral Artery
Magnetic Resonance Angiography
Research Ethics Committees
Child Abuse
Incidence
Brain Edema
Brain
Subarachnoid Hemorrhage
Brain Injuries
Neck

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Cervical spine imaging for young children with inflicted trauma : Expanding the injury pattern. / Baerg, Joanne; Thirumoorthi, Arul; Vannix, Rosemary; Taha, Asma; Young, Amy; Zouros, Alexander.

In: Journal of Pediatric Surgery, 03.01.2017.

Research output: Contribution to journalArticle

Baerg, Joanne ; Thirumoorthi, Arul ; Vannix, Rosemary ; Taha, Asma ; Young, Amy ; Zouros, Alexander. / Cervical spine imaging for young children with inflicted trauma : Expanding the injury pattern. In: Journal of Pediatric Surgery. 2017.
@article{d8f1b4b7527e463faab35ecee57addde,
title = "Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern",
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.",
keywords = "Cervical spine injury, Inflicted trauma, Pattern of injury, Shaken infant",
author = "Joanne Baerg and Arul Thirumoorthi and Rosemary Vannix and Asma Taha and Amy Young and Alexander Zouros",
year = "2017",
month = "1",
day = "3",
doi = "10.1016/j.jpedsurg.2017.01.049",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Cervical spine imaging for young children with inflicted trauma

T2 - Expanding the injury pattern

AU - Baerg, Joanne

AU - Thirumoorthi, Arul

AU - Vannix, Rosemary

AU - Taha, Asma

AU - Young, Amy

AU - Zouros, Alexander

PY - 2017/1/3

Y1 - 2017/1/3

N2 - 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.

AB - 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.

KW - Cervical spine injury

KW - Inflicted trauma

KW - Pattern of injury

KW - Shaken infant

UR - http://www.scopus.com/inward/record.url?scp=85012934048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012934048&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2017.01.049

DO - 10.1016/j.jpedsurg.2017.01.049

M3 - Article

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -