Polk-Williams Alison, Carr Brendan G, Blinman Thane A, Masiakos Peter T, Wiebe Douglas J, Nance Michael L
Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Pediatr Surg. 2008 Sep;43(9):1718-21. doi: 10.1016/j.jpedsurg.2008.06.002.
Blunt cervical spine injury (CSI) is rare in the pediatric population. The objective of this study was to better characterize the incidence and type of CSI in young children (age <3 years) using a large, trauma center-based data set.
The National Trauma Data Bank (NTDB) was reviewed for the period January 2001 to December 2005 for patients younger than 3 years of age with a blunt CSI (International Classification of Diseases, Ninth Revision, 805x, 806x, 952x). Demographic, injury, and outcome information were reviewed. Data management was performed using SAS (SAS, Cary, NC) and Stata (Stata Corp, College Station, TX). Patients with CSI were compared to patients without CSI of similar age. Means were compared with the Wilcoxon rank sum test, medians were compared with a nonparametric test, and count data were compared with the chi(2) test, with significance set at <.05.
For the period of review, 95,654 young children (age <3 years) with blunt trauma were identified in the NTDB. The overall population had a median Injury Severity Score (ISS) of 4, and most patients (77.01%) had a Glasgow Coma Score (GCS) of 15. There were 1523 (1.59%) patients with a CSI (spinal cord and/or column), including 366 patients (0.38%) with a spinal cord injury (with or without column injury) and 182 (0.19%) with an isolated spinal cord injury (SCIWORA). The CSI and non-CSI populations did not differ regarding median GCS (15 for both groups), but the CSI population had a significantly higher median ISS (14 vs 4, respectively; P < .001). Compared to patients without CSI, the CSI population was more likely to die in the emergency department (2.04% vs 1.25%; P = .007) or be admitted to the intensive care unit (45.3% vs 16.9%; P < .001). Nearly half of all cervical spine fractures (48%) and more than half of cervical spinal cord injuries (53%) were in the lower cervical spine (C5-7). MVCs were the most common injury mechanism (66%) followed by falls (15%). A CSI was observed in 3.2% of all motor vehicle crashes (MVCs).
In this trauma center population, these findings confirm the infrequency of blunt CSI in the youngest (age <3 years) trauma patients. The frequency of injuries to the lower cervical spine is higher than previously appreciated. MVCs are the most likely injury mechanism for this potentially devastating injury.
钝性颈椎损伤（CSI）在儿科人群中较为罕见。本研究的目的是利用一个基于大型创伤中心的数据集，更好地描述幼儿（年龄<3岁）CSI的发病率和类型。
回顾国家创伤数据库（NTDB）2001年1月至2005年12月期间年龄小于3岁且患有钝性CSI（国际疾病分类第九版，805x、806x、952x）的患者。对人口统计学、损伤和结局信息进行了回顾。使用SAS（SAS，卡里，北卡罗来纳州）和Stata（Stata公司，大学城，德克萨斯州）进行数据管理。将患有CSI的患者与年龄相似但无CSI的患者进行比较。均值采用Wilcoxon秩和检验进行比较，中位数采用非参数检验进行比较，计数数据采用卡方检验进行比较，显著性设定为<.05。
在回顾期间，NTDB中识别出95654名遭受钝性创伤的幼儿（年龄<3岁）。总体人群的损伤严重程度评分（ISS）中位数为4，大多数患者（77.01%）的格拉斯哥昏迷评分（GCS）为15。有1523名（1.59%）患者患有CSI（脊髓和/或脊柱），其中366名（0.38%）患有脊髓损伤（伴有或不伴有脊柱损伤），182名（0.19%）患有孤立性脊髓损伤（SCIWORA）。CSI组和非CSI组的GCS中位数无差异（两组均为15），但CSI组的ISS中位数显著更高（分别为14和4；P<.001）。与无CSI的患者相比，CSI组患者更有可能在急诊科死亡（2.04%对1.25%；P=.007）或入住重症监护病房（45.3%对16.9%；P<.001）。几乎一半的颈椎骨折（48%）和超过一半的颈脊髓损伤（53%）发生在下颈椎（C5-7）。机动车碰撞（MVC）是最常见的损伤机制（66%），其次是跌倒（15%）。在所有机动车碰撞（MVC）中有3.2%观察到CSI。
在这个创伤中心人群中，这些发现证实了最年幼（年龄<3岁）创伤患者中钝性CSI的罕见性。下颈椎损伤的频率高于先前的认识。机动车碰撞（MVC）是这种潜在毁灭性损伤最可能的损伤机制。
