, et al
Cervical spine imaging and injuries in young children with non-motor vehicle crash-associated traumatic brain injury
Pediatric Emergency Care
; doi:

Investigators from multiple institutions conducted a retrospective study to assess the frequency of cervical spine imaging and injury in children with non-motor vehicle crash (MVC)-associated traumatic brain injury (TBI). Children were eligible if they presented to one of 4 participating hospitals and received an ICD-9 code for non-MVC-associated injury types, such as fracture, TBI, and internal injury. After excluding those injured in MVCs, a smaller sample was randomly selected for chart review to identify a final cohort of children with TBI, defined as an intracranial hemorrhage or parenchymal injury documented on a CT or MRI. A stratified approach was used to identify this chart review sample to ensure adequate representation by age, gender, injury, and hospital. Demographics of this final cohort of children with non-MVC-associated TBI were abstracted from the medical record.

The primary predictor variables were: (a) etiology of TBI, categorized as abusive head trauma (AHT), accidental, and indeterminate; and (b) head injury severity, measured using the Maximum Abbreviated Injury Scale (MAIS) populated using ICD-9 codes, with a MAIS score of ≥3 was considered a moderate or severe head injury. The primary outcome variable was abnormal findings on cervical spine CT or MRI, with abnormal findings defined as vertebral injuries (factures, dislocations, or other), extraaxial spinal hemorrhages (subdural, epidural, subarachnoid, or unspecified), cord injuries, ligamentous injuries, and soft-tissue injuries with associated hemorrhage. Investigators determined the frequency of cervical spine CT or MRI among children with non-MVC-associated TBI and assessed the association between predictor and outcome variables using chi-squared tests.

There were 328 children with non-MVC-associated TBI included in the analysis. Most (60.3%) were <6 months old, male (64.3%), and white (66.9%). TBI etiology was accidental in 52.2%, AHT in 39.4%, and indeterminate in 8.4%. Overall, 79.1% had a MAIS score of ≥3, and cervical spine CT or MRI was obtained in 19.1%. Of those with cervical spine CT or MRI, 22.1% had an abnormality, with more children with AHT (31.3%) having a cervical spine abnormality than children with accidental (7.1%) TBI etiology. The most common abnormality found on cervical spine CT or MRI was extra-axial spinal hemorrhages (15.1%); cord injuries were found in 3.5%, all of whom had AHT. Significantly more children with MAIS score of ≥3 (vs <3) had a cervical spine abnormality.

The investigators conclude that cervical spine injuries are common in children with non-MVC-associated TBI, especially among those with TBI due to abusive head trauma.

Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

TBI, especially with a concomitant cervical spine injury, has significant morbidity and mortality in children. In general, TBI rates are greater than that...

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