Spine injuries in polytraumatized pediatric patients: characteristics and experience from a Level I trauma center over two decades.

BACKGROUND

Spine injuries, a common component in polytrauma, are relatively rare in pediatric patients. Previous studies mainly described injuries to the cervical region, whereas information of injury patterns to the thoracic and lumbosacral region lack in the current literature. The aim of this study was to determine the incidence and characteristics of polytraumatized children and associated spine injuries in different pediatric development ages.

METHODS

A cohort review of all pediatric patients with the diagnosis of polytrauma and associated spine injury, admitted to a urban Level I trauma center, was conducted over an 18-year period from January 1992 to December 2010. Patients were stratified into four developmental age groups: infants/toddlers (age 0-4 years), preschool/young children (age 5-9 years), preadolescents (age 10-14 years), and adolescents (age 15-17 years). Demographics, clinical injury data, patterns of spine injuries, associated injuries, treatment, and outcome were abstracted and analyzed.

RESULTS

From a database of 897 severely (Injury Severity Score ≥ 16) injured pediatric patients, 28 children met the inclusion criteria. The mean age was 12.7 years (range, 1.3-16.7 years), and there were 18 males and 10 females. Younger children (age 0-9 years) sustained more injuries to the upper spine region, whereas injuries to the lumbar region were only seen in adolescents. Nine (32%) patients received surgical treatment for spine fracture or subluxation, and 15 (54%) were treated by nonoperative means. Four patients (14%) received only palliative treatment due to medical futility. Overall, the most commonly associated injury was thoracic injury (89%) followed by traumatic brain injury (64%).

CONCLUSION

The age-related anatomy and physiology predispose younger children to upper spine injuries in contrast to lower spine injuries seen in adolescents. Predictors of mortality include pathologic pupillary light reflex, high Injury Severity Score and Abbreviated Injury Scale score, and a low Glasgow Coma Scale score at admission. Thoracic injuries were the most common associated injuries followed by traumatic brain injury.

LEVEL OF EVIDENCE

Prognostic study, level III.