Anesthesia Management: Pediatric Cervical Spine Injuries

Authors: Leonard JR et al., Pediatrics 2014 May 1; 133:e1179

Risk for death is highest in children with significant concomitant injuries.

Researchers examined characteristics of pediatric cervical spine injuries in a secondary analysis of children younger than 16 years treated at 17 pediatric hospitals in the Pediatric Emergency Care Applied Research Network (PECARN).

Of 540 children, 21% required surgical fixation, and 7% died. In children aged less than 7 years, motor vehicle collision (MVC) was the most common mechanism of injury, and about 75% of injuries were in the axial region (C1-2). In children 8 to 15 years old, MVCs and sports injuries each accounted for 23% of injuries; 47% of injuries were axial.

Poor outcomes (death or persistent neurologic deficits) were associated with substantial injuries to the head or body. Persistent neurologic deficit occurred in 37% of children aged less than 2 years and in greater than 60% of older children. Sixty-eight children (13%), most in the older group, had spinal cord injury without radiographic abnormalities (SCIWORA), defined as neurologic deficit with normal cervical radiographs, computed tomography, and magnetic resonance imaging (MRI); only 6 had persistent neurologic deficits. Of 16 patients with cord injury identified only with MRI, 10 had persistent neurologic deficits, and 1 died.

Comment

Magnetic resonance imaging is indicated for children with neurologic deficits despite normal radiographs and computed tomography scans. As would be expected, children with significant concomitant injuries are at highest risk for death.