Piatt Joseph
J Neurosurg Pediatr. 2018 Oct;22(4):384-392. doi: 10.3171/2018.3.PEDS1890. Epub 2018 Jul 6.
Penetrating injury of the spine in childhood commonly causes profound and life-long disability, but it has been the object of very little study. The goal of the current report is to document temporal trends in the nationwide incidence of this condition and to highlight the differences between penetrating injuries and closed injuries.
The Kids' Inpatient Database was queried for spinal injuries in 1997, 2000, 2003, 2006, 2009, and 2012. Penetrating mechanism was determined by diagnostic coding for open injuries and by mechanistic codes for projectiles and knives. Nationwide annual incidences were calculated using weights provided for this purpose. Unweighted data were used as a cross-sectional sample to compare closed and penetrating injuries with respect to demographic and clinical factors. The effect of penetrating mechanism was analyzed in statistical models of death, adverse discharge, and length of stay (LOS).
The nationwide incidence of penetrating spinal injury in patients less than 18 years of age trended downward over the study period. Patients with penetrating injury were older and much more predominantly male than patients with closed injuries. They resided predominantly in zip codes with lower median household incomes, and they were much more likely to have public health insurance or none at all. They were predominantly black or Hispanic. The risk of hospital death was no different, but penetrating injuries were associated with much higher rates of adverse discharge after LOS, averaging twice as long as closed injuries. Brain, visceral, and vascular injuries were powerful predictors of hospital death, as was upper cervical level of injury. The most powerful predictor of adverse discharge and LOS was spinal cord injury, followed by brain, visceral, and vascular injury and penetrating mechanism.
Because its pathophysiology requires no elucidation, because the consequences for quality of life are dire, and because the population at risk is well defined, penetrating spinal injury in childhood ought to be an attractive target for public health interventions.
儿童脊柱穿透伤通常会导致严重且终身的残疾，但对此研究甚少。本报告的目的是记录全国范围内该疾病发病率的时间趋势，并突出穿透伤与闭合伤之间的差异。
查询1997年、2000年、2003年、2006年、2009年和2012年儿童住院数据库中的脊柱损伤情况。穿透机制通过开放性损伤的诊断编码以及射弹和刀具的机制编码来确定。使用为此目的提供的权重计算全国年度发病率。未加权数据用作横断面样本，以比较闭合伤和穿透伤在人口统计学和临床因素方面的情况。在死亡、不良出院和住院时间（LOS）的统计模型中分析穿透机制的影响。
在研究期间，18岁以下患者脊柱穿透伤的全国发病率呈下降趋势。穿透伤患者比闭合伤患者年龄更大，男性占比更高。他们主要居住在家庭收入中位数较低的邮政编码地区，并且更有可能拥有公共医疗保险或根本没有保险。他们主要是黑人或西班牙裔。医院死亡风险没有差异，但穿透伤与住院时间后不良出院率高得多相关，平均住院时间是闭合伤的两倍。脑、内脏和血管损伤是医院死亡的有力预测因素，损伤位于上颈椎水平也是如此。不良出院和住院时间的最有力预测因素是脊髓损伤，其次是脑、内脏和血管损伤以及穿透机制。
由于其病理生理学无需阐明，由于对生活质量的影响严重，并且由于高危人群明确，儿童脊柱穿透伤应该是公共卫生干预的一个有吸引力的目标。
