Citation

Piatt J. J. Neurosurg. Pediatr. 2018; 22(4): 384-392.

Affiliation

Division of Neurosurgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, and Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Copyright

(Copyright © 2018, American Association of Neurological Surgeons)

DOI

10.3171/2018.3.PEDS1890

PMID

29979127

Abstract

OBJECTIVE 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.

METHODS 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).

RESULTS 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.

CONCLUSIONS 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.

Language: en

Keywords

AUC = area under the curve; HCUP = Healthcare Utilization Project; KID = Kids’ Inpatient Database; LOS = length of stay; NACHRI = National Association of Children’s Hospitals and Related Institutions; OR = odds ratio; SCI = spinal cord injury; TBI = traumatic brain injury; epidemiology; firearm; nationwide trend; pediatric spinal injury; spinal cord injury; spine; trauma