Citation

Davison MA, Button KD, Benzel EC, Weaver BT, Rundell SA. World Neurosurg. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.wneu.2022.03.104

PMID

35367390

Abstract

BACKGROUND: Shaken Baby Syndrome occurs following inertial loading of the pediatric head resulting in retinal hemorrhaging, subdural hematoma, and encephalopathy. However, the anatomically vulnerable cervical spine receives little attention. Automotive safety literature is replete with biomechanical data involving forward-facing pediatric surrogates in frontal collisions, an environment analogous to shaking. Publicly-available data involving child occupants was utilized to study pediatric neck and head injury potential. We hypothesized that inertial loading provides a greater risk of injury to the cervical spine compared to the head.

METHODS: Full-scale automotive crash tests (n=131) and deceleration sled tests (n=32) utilizing forward-facing 3-year-old surrogates with head accelerometers and cervical force sensors were analyzed. 167 full-scale vehicle and 33 sled test runs were assessed in the context of published Injury Assessment Reference Values (IARVs) for closed head injury (HIC(15)) and cervical tensile strength in the 3-year-old model.

RESULTS: One hundred sixty-one (96%) child surrogates in full-scale crash tests exceeded the cervical peak-tension IARV while only 37 (22%) surpassed the HIC(15) IARV. Similarly, in sled testing runs, 27 (82%) pediatric surrogates exceeded cervical tension IARVs while 1 (3%) surpassed the HIC(15) IARV. In both full-scale and sled tests, all surrogates surpassing the HIC(15) IARV also exceeded the cervical tension IARV. Positive linear correlations were observed between HIC(15) and cervical tensile forces in both full-scale vehicle (R(2)=0.15) and sled testing runs (R(2)=0.54).

CONCLUSIONS: These data support the hypothesis that inertial loading of the head provides a greater injury risk to the cervical spine when compared to closed-head injury.

Language: en

Keywords

Pediatrics; Biomechanics; Abusive Head Trauma; Automotive Safety; Craniocervical Trauma; Pediatric Head Trauma; Shaken Baby Syndrome