The epidemiology of childhood and adolescent traumatic spinal cord injury in the United States: 2007-2010.
Selvarajah Shalini,Schneider Eric B,Becker Daniel,Sadowsky Cristina L,Haider Adil H,Hammond Edward R
Journal of neurotrauma
The burden of acute traumatic spinal cord injury (TSCI) among U. S. children and adolescents was last described over a decade ago using inpatient data. We describe cumulative incidence, mortality, discharge disposition, and inflation-adjusted charges of childhood and adolescent TSCI in the U.S. using emergency department (ED) data from the Nationwide Emergency Department Sample (2007-2010). Patients ages 17 years and younger with a diagnosis of acute TSCI were identified using the International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 806.* and 952.* (N = 6132). The cumulative incidence of childhood and adolescent TSCI averaged 17.5 per million population per year. The median age at presentation was 15 years (interquartile range [IQR] = 12-16) and the majority of patients were male (72.5%). The overall median new injury severity score (NISS) was 16 (IQR = 9-27), remaining unchanged during the study duration (p=0.703). Children 5 years and younger were more likely to be injured from a road traffic accident (RTA; 50.9%), sustain C1-C4 injuries (47.4%), have more severe injury (median NISS = 22; IQR = 13-29), and concurrent brain injury (24%) compared to older children and adolescents, p<0.001. Firearms were implicated in 8.3% of injuries, of which 94.7% were among adolescents ages 13-17 years. Of the 35 TSCI-related ED deaths, 40% occurred among children ages 5 years and younger. 62.4% of patients required inpatient admission. Despite stable cumulative incidence and overall injury severity, ED treatment charge per visit increased on average $1394 from $3495 in 2007 to $4889 in 2010 (p=0.008). RTA-related TSCI disproportionately affects young children, while firearm-related TSCI is most common among adolescents. These findings inform TSCI prevention strategies. Prevention may be key in mitigating rising healthcare cost.
Pediatric Cervical Spine and Spinal Cord Injury: A National Database Study.
Shin John I,Lee Nathan J,Cho Samuel K
STUDY DESIGN:A retrospective administrative database analysis. OBJECTIVE:The aim of this study was to investigate the incidence and characteristics of pediatric cervical spine injury (PCSI) utilizing the Kids' Inpatient Database (KID). SUMMARY OF BACKGROUND DATA:PCSI is debilitating, but comprehensive analyses have been difficult due to its rarity. There have been a few database studies on PCSI; however, the studies employed databases that suffer from selection bias. METHODS:The triennial KID was queried from years 2000 to 2012 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Pediatric admissions were divided into five age groups reflecting different developmental stages. PCSI was analyzed in terms of trend, demographics, injury characteristics, hospital characteristics, comorbidities, and outcomes variables. Multivariate logistic regression analyses were used to identify independent risk factors for PCSI among trauma admissions and to identify independent risk factors for mortality among PCSI admissions. RESULTS:Over the past decade, the overall prevalence of traumatic PCSI was 2.07%, and the mortality rate was 4.87%. Most frequent cause of PCSI was transportation accidents, accounting for 57.51%. Upper cervical spine injury (C1-C4), cervical fracture with spinal cord injury, spinal cord injury without radiographic abnormality (SCIWORA), and dislocation showed a decreasing trend with age. Some comorbidities, including, but not limited to, fluid and electrolyte disorders, and paralysis were common across all age groups, while substance abuse showed a bimodal distribution. Independent risk factors for PCSI after trauma were older cohorts, non-Northeast region, and transportation accidents. For mortality after PCSI, independent risk factors were younger cohorts, transportation accidents, upper cervical spine injury, dislocation, and spinal cord injuries. Median length of stay and cost were 3.84 days and $14 742. CONCLUSION:Pediatric patients are highly heterogeneous, constantly undergoing behavioral, environmental, and anatomical changes. PCSI after trauma is more common among older cohorts; however, mortality after sustaining PCSI is higher among younger patients. LEVEL OF EVIDENCE:4.
[Clinical characteristics analysis of 120 cases of pediatric spinal cord injury without radiologic abnormality].
Wang Y J,Zhou H J,Wei B,Liu G L,Zheng Y,Zhang Y,Hao C X,Kang H Q,Yuan Y,Lu X L
Zhonghua yi xue za zhi
OBJECTIVE:To study the epidemiologic characteristics of pediatric spinal cord injury without radiologic abnormality. METHODS:A retrospective analysis was performed and 120 cases of children with spinal cord injury without radiologic abnormality were admitted in China Rehabilitation Research Center from January 2005 to December 2014.The gender, age, causes of injury, injury condition and complication were analyzed. All cases were divided into two groups (0-7 years old and 8-13 years old) according to age. RESULTS:One hundred and twenty cases included 31 boys (25.8%) and 89 girls (74.2%). Most of the children were 0-7 years old (96 cases, 80.0%). The top 3 causes of spinal cord injury were sports activities (60 cases, 50.0%), traffic accident (25 cases, 29.2%) and other trauma (11 cases, 12.5%). Seventy-one cases were low-energy injury (59.2%) and 49 cases were high-energy trauma (40.8%), most of low-energy injury were completely injured (56 cases, 78.9%). The complication rate was 59.2% and the top 3 complications were urinary infection (35 cases, 29.2%), hydronephrosis (12 cases, 10.0%) and pressure ulcers (10 cases, 8.3%). CONCLUSION:It is needed to pay more attention to pediatric spinal cord injury without radiologic abnormality caused by low-energy injury, especially children aged 0-7 years old with history of slight injury, and be careful about spinal cord injury without radiologic abnormality result from high-energy damage.
What are the trends and demographics in sports-related pediatric spinal cord injuries?
Nadarajah Vidushan,Jauregui Julio J,Perfetti Dean,Shasti Mark,Koh Eugene Y,Henn Ralph Frank
The Physician and sportsmedicine
OBJECTIVES:Pediatric spinal cord injury (PSCI) is a devastating injury that can cause significant long-term consequences. The purpose of this study is to calculate and report the prevalence of PSCI, identify risk factors for sports-related PSCI, and evaluate associated factors. METHODS:The data sets of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 2000-2012 were analyzed using ICD-9-CM external cause of injury codes to identify the mechanism of injury contributing to PSCI hospitalization. We then extracted demographic data on each admission including age, gender, race, and year of admission. We further stratified the data by sports-related cases of injury. Multivariate logistic regression analyses were used to identify independent risk factors. RESULTS:Of our study population, 0.8% had a documented diagnosis of spinal cord injury (SCI). The most common documented external cause of injury code was motor vehicle accidents, representing roughly half of all cases in patients 0-9 years-old (p = 0.001). PSCI due to sports as an external cause of injury was more prevalent in patients 10-17 years old, and was especially prevalent in the 10-13 year-old age category in which sports-related PSCI reached a high of 25.6%. Risk factors for traumatic PSCI after a sports-related external cause included being of older age, male, and white. CONCLUSIONS:The prevalence of SCI increased with age. Given the popularity of youth sports in the United States, parents and sports officials should be aware of the increased risk of sports-related PSCI among patients 10-17 years old. LEVEL OF EVIDENCE:Level III, retrospective cohort study.
Spinal cord injuries without radiologic abnormality in children: a systematic review.
Carroll T,Smith C D,Liu X,Bonaventura B,Mann N,Liu J,Ebraheim N A
STUDY DESIGN:Systematic review. OBJECTIVES:The objective of this study is to systematically review the literature for pediatric cases of spinal cord injuries without radiologic abnormality (SCIWORA) to investigate any possible relationship between initial neurologic impairment and eventual neurologic status. SETTING:A university department of orthopedics. METHODS:Following the preferred reporting items for systemic reviews and meta-analysis (PRISMA) guidelines for systematic review, the databases of PubMed and OvidSP were electronically searched for articles that use individuals under 18 years old, have trauma resulting in spinal cord injury and have no fractures or dislocations on radiographs. When available, the patients' age, sex, mechanism of injury and spinal cord level were recorded. Individuals with cervical injury, who had specific information on cervical level and mechanism of injury, were recorded as well. Patients who reported specific magnetic resonance imaging findings and the time from the injury were also reported. When possible, the American Spinal Injury Association Impairment Scale (AIS) was determined initially after the injury and then at last follow-up. RESULTS:A total of 433 pediatric patients were identified with SCIWORA. The most prevalent mechanism of injury was sports-related injury cases (39.83%) followed by fall (24.18%) and motor vehicle-related (23.18%) injuries. The mean improvement recorded for all patients was 0.89 AIS grades. CONCLUSION:The most common mechanism of injury was sports-related and cervical injury, which occurred more frequently than other levels. Initial AIS grade A showed poorer outcomes in the pediatric population compared with the adult population. Initial presentation of D showed the highest likelihood of no permanent neurologic impairment (AIS of E).
Epidemiology, Clinical Features and Consequences of Spinal Cord Injury in Children.
Darain Haider,Arsh Aatik,Zeb Amir,Ilyas Syed Muhammad,Muhammad Dildar,Khan Muhammad Naseem
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
OBJECTIVE:To describe epidemiology, clinical features and clinical consequences of Spinal Cord Injury (SCI) in children. STUDY DESIGN:Case series. PLACE AND DURATION OF STUDY:Paraplegic Centre, Hayatabad, Peshawar, from July 2011 to March 2017. METHODOLOGY:SCI patients having age up to 15 years, admitted to Paraplegic Centre, were inducted in 2017. Exclusion criteria was foreign-national SCI patients, and/or SCI patients re-admitted to paraplegic centre. List of all SCI patients admitted to the centre was retrieved and 102 patients were identified. Data of these patients was evaluated for demographic information, physiological intactness (complete SCI/incomplete SCI), neurological level and complications. RESULTS:A total of 102 patients (66 males and 36 females) with mean age 10.9 ±3.7 years were included in this study. Firearm injury was the most common cause (n=39, 38.2%) of SCI in these patients, followed by fall from height (n=23, 22.5%), road traffic accidents (n=14, 13.7%), and weight fallen over (n=14, 13.7%). Bomb blast injury (n=7, 6.9%), diving accident (n=3, 2.9%), and sports related injuries (n=2, 2.0%). Majority of the patients (n=82, 80.4%) had complete SCI (ASIA A); the commonest SCI level was thoracic region (n=59, 57.8%) and the least reported region was (n=14, 13.7%) cervical. Out of the total, 50 (49.0%) patients had pressure ulcer in which 15 (30.0%) patients were having grade IV pressure ulcer, 9 (18.0%), 15 (30.0%) and 11 (22.0%) patients were had grade I, grade II and grade III pressure ulcer, respectively. CONCLUSION:Majority of causes of SCI in children are similar to those reported in adult population. However, the commonest causes of SCI in children in Pakistan were firearm injury and bomb blast, which are rarely reported in other countries. Like adult population, these children with SCI are prone to developing pressure ulcer.
U.S. Estimates of Pediatric Spinal Cord Injury: Implications for Clinical Care and Research Planning.
Dhillon Jaspreet K,Shi Junxin,Janezic Alyssa,Wheeler Krista K,Xiang Henry,Leonard Julie C
Journal of neurotrauma
The aim of this study was to provide accurate estimates and characterizations of children with spinal cord injuries (SCIs) and for the subset that are appropriate for inclusion in clinical trials. We identified children <18 years of age with SCI International Classifications of Diseases, Ninth Revision, Clinical Modification Codes (ICD-9-CM codes) from the 2006, 2009, and 2012 Kids' Inpatient Database. We excluded those with late effects, transfers to other hospitals, unspecified injury levels, and hospital stays <48 h. We then used conventional rationale to identify children who were eligible for SCI clinical trials. Over 3 years, 2484 children had SCI ICD-9-CM codes; 1342 had coding consistent with true SCI and 706 satisfied clinical trial inclusion criteria, yielding national estimates of 2013 and 1062, respectively. Of children with clinical trial eligible SCI, injuries were more common in the cervical region (66.1%), males (65.5%), older children (51.1% were 16-17 years old), and the South (49.8%). The majority were treated at urban teaching hospitals (84.6%); however, only 20.3% were treated at pediatric-specific centers. Of the 445 sample hospitals treating children with SCI, 66.3% treated just 1 child in the 3-year period. Children eligible for SCI clinical trials represented less than one third of children with SCI ICD-9-CM codes. These children were regionally localized to the South, with few receiving treatment at pediatric-specific centers or centers that frequently care for children with SCI. These findings highlight the importance of carefully assessing the national distribution of children with SCI, so that resources are appropriately allocated to optimize clinical care and research outcomes.
Epidemiology of Pediatric Traumatic and Acquired Nontraumatic Spinal Cord Injury in Ireland.
Smith Eimear,Finn Susan,Fitzpatrick Patricia
Topics in spinal cord injury rehabilitation
To examine the epidemiology of pediatric traumatic (TSCI) and acquired nontraumatic spinal cord injury (NTSCI) in Ireland. There are few studies reporting pediatric TSCI incidence and fewer of pediatric NTSCI incidence, although there are several case reports. As there is a single specialist rehabilitation facility for these children, complete population-level data can be obtained. Retrospective review of prospectively gathered data in the Patient Administration System of the National Rehabilitation Hospital of patients age 15 years or younger at the time of SCI onset. Information was retrieved on gender, age, etiology, level of injury/AIS. Population denominator was census results from 1996, 2002, 2006, and 2011, rolled forward. Since 2000, 22 children have sustained TSCI and 26 have sustained NTSCI. Median (IQR) age at TSCI onset was 6.3 (4.4) years, and at NTSCI onset it was 7.3 (8.1) years. Most common TSCI etiology was transportation ( = 10; 45.5%), followed by surgical complications ( = 8; 36.4%); most common injury type was complete paraplegia ( = 12; 54.5%) followed by incomplete paraplegia ( = 5; 22.7%). Most common NTSCI etiology was transverse myelitis ( = 11; 42.3%) followed by vascular ( = 5; 20%); most common injury type was incomplete paraplegia ( = 17; 65.4%) followed by incomplete tetraplegia ( = 6; 24%). Incidence of TSCI ranged from 0 to 3.1 per million per year; incidence of NTSCI ranged from 0 to 6.5 per million per year. Incidence of SCI in Ireland seems similar to or slightly lower than other developed countries. Injury patterns are also similar, considering variations in reporting methods.
Variation in patterns of hospitalization and associated resource use among children with spinal cord injury in the U.S.
Odetola Folafoluwa O,Gebremariam Achamyeleh
INTRODUCTION:Trauma is a leading cause of mortality and morbidity among children in the U.S. There is paucity of data on the triage of children with spinal cord injury (SCI) to definitive trauma care, and it is unknown if clinical outcomes and resource utilization for children hospitalized with SCI vary according to the settings where trauma care is provided. The study was conducted to describe recent patterns of emergency department (ED) evaluation for paediatric SCI in the U.S., and to characterize outcomes and resource use for children hospitalized at non-trauma centres versus trauma centres. MATERIALS AND METHODS:Secondary analysis of a national database on injured children 0-20 years evaluated at U.S. EDs and either hospitalized or released, in 2009-2012. In-hospital mortality, duration of stay, and overall charges, were compared according to trauma centre status of the treating hospital. RESULTS:Of an estimated 67 million annual paediatric visits to the ED for trauma evaluation nationally in 2009-2012, 2317 had SCI. Majority (87%) of children evaluated for SCI were under 6 years of age, and boys comprised 73% of the visits. Injuries were caused mainly by motor vehicle accidents, falls, non-transport-related accidents, and firearms. The South census region had the most ED visits and hospitalizations. Majority (92%) of the most severely injured was evaluated at trauma centres, and more visits to trauma centres (81% vs. 18%, p=0.022) resulted in hospitalization. Among an estimated 1570 hospitalizations of children with SCI from the ED nationally, children at trauma centres were more likely to have major injuries (67% vs. 44%, p=0.001), similar mortality, longer average hospital stay, and higher charges, compared with children hospitalized at non-trauma centres. CONCLUSION:Significant demographic and geographical variation exists in national patterns of hospital care for paediatric SCI. Higher severity of patient injury was associated with concomitantly higher hospital resource use at trauma centres.
Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years.
Canosa-Hermida E,Mora-Boga R,Cabrera-Sarmiento J J,Ferreiro-Velasco M E,Salvador-de la Barrera S,Rodríguez-Sotillo A,Montoto-Marqués A
The journal of spinal cord medicine
OBJECTIVE:To analyze the characteristics of traumatic spinal cord injury in children of Galicia (Spain). DESIGN:Descriptive and retrospective study. METHODS:Data extracted from the internal registry of the Spinal Cord Injury Unit and the patient's medical records, between March 1988 and December 2014. Inclusion criteria: patients aged ≤ 17 years with a traumatic spinal cord injury. Total patients, percentages, incidence, ASIA scale results and improvement. RESULTS:A total of 68 patients were included. The incidence was 5.6 cases/1,000,000 inhabitants/year. The mean age was 14.4 years (median: 16). Only 25% were younger than 15. Male patients accounted for 73.5% of the total. The main cause were traffic accidents (60.3%; n = 41), being higher (77.8%) in children ≤ 10 years. Other etiologies included falls (19.1%), diving accidents (16.2%) and other causes (4.4%). Eleven patients (16.2%) had injuries classified as SCIWORA, 8 (72.7%) of them aged ≤ 10 years. The mean age of the SCIWORA group was 7.5 years versus 15.7 years in the non-SCIWORA group (P < 0.001). Half (50%) of these patients had a complete spinal cord injury and, of these, 64.6% were paraplegic. CONCLUSIONS:Traumatic spinal cord injuries are rare in children, and most cases occur between 15 and 17 years. Unlike in adults, SCIs in children mostly involve the thoracic spine. Most patients aged ≤ 10 years have SCIWORA. The most common etiology continues to be traffic accidents, although sports accidents prevail among adolescent patients.