@article{ref1,
title="Cervical spine injuries in young children: pattern and outcomes in accidental versus inflicted trauma",
journal="Journal of surgical research",
year="2017",
author="Baerg, Joanne and Thirumoorthi, Arul and Hazboun, Rajaie and Vannix, Rosemary and Krafft, Paul and Zouros, Alexander",
volume="219",
number="",
pages="366-373",
abstract="BACKGROUND: The aim of the study was to compare the cervical spine (c-spine) pattern of injury and outcomes in children below 3 y with a head injury from confirmed inflicted versus accidental trauma. <br><br>METHODS: After Institutional Review Board approval, data were prospectively collected between July 2011 and January 2016. Inclusion criteria were age below 3 y, a loss of consciousness, and any one of the following initial head computed tomography (CT) findings (subdural hematoma, intraventricular, intraparenchymal, subarachnoid hemorrhage, or cerebral edema). A protocol of brain and neck magnetic resonance imaging and magnetic resonance angiography was instituted. Brain and neck imaging results, clinical variables, and outcomes were recorded. Data were compared by t-test for continuous and Fisher exact test for categorical variables. <br><br>RESULTS: 73 children were identified, 52 (71%) with inflicted and 21 (29%) with accidental trauma. The median age was 11 mo; (range: 1-35 mo). Ten (14%) had c-spine injuries, 7/52 (13%) inflicted, and 3/21 (14%) accidental. The mechanism was shaking for all inflicted and motor vehicle accident or pedestrian struck for accidental c-spine injuries. The inflicted group were significantly younger (P = 0.03), had higher Injury Severity Scores (P = 0.02), subdural hematomas (P = 0.03), fractures (P = 0.03), retinal hemorrhages (P = 0.02), brain infarcts (P = 0.01), and required cardiopulmonary resuscitation (P = 0.01). Seven with inflicted trauma died from brain injury (9.5%), one had atlanto-occipital dissociation. Six mortalities (86%) had no c-spine injury. Six with inflicted c-spine injuries survived with neurologic impairment, whereas three with accidental survived without disability, including one atlanto-occipital dissociation. <br><br>CONCLUSIONS: Compared to accidental trauma, young children with inflicted c-spine injuries have more multisystem trauma, long-term disability from brain injury, and an injury pattern consistent with shaking.<br><br>Copyright © 2017 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0022-4804",
doi="10.1016/j.jss.2017.06.053",
url="http://dx.doi.org/10.1016/j.jss.2017.06.053"
}