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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Cornacchia A, Pelotti S, Fais P. Pediatric motor vehicle crashes injuries: A systematic review for forensic evaluation. Int J Legal Med 2024; 138:1329-1341. [PMID: 38337078 PMCID: PMC11164731 DOI: 10.1007/s00414-024-03174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Children involved in car crashes can experience either direct trauma or inertial injuries resulting from interactions with external objects, such as other vehicles, or with the restraint system. Furthermore, improper use of restraint systems can lead to additional severe injuries. Recent reports from international institutions underscored the persistent prevalence of inadequate restraint systems utilization and this widespread issue increases children's vulnerability and risk of injuries.The aim of this study is to provide a systematic review of the literature on injuries sustained in children involved in road accidents describing and analyzing elements useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving pediatric passengers. A total of 69 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the accident was examined and discussed.The review highlights that in motor vehicle accidents involving children, the forensic evaluation of both the cause of death and accident dynamics needs to consider several factors, such as the child's age, the type of restraint system employed, and the specific passenger seat occupied. Considering the complexity of the factors that can be involved in this road accident, it is crucial that there is a comprehensive exchange of information between the judge and the medical expert.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Maria Paola Bonasoni
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Angela Cornacchia
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Luckhurst CM, Wiberg HM, Brown RL, Bruch SW, Chandler NM, Danielson PD, Draus JM, Fallat ME, Gaines BA, Haynes JH, Inaba K, Islam S, Kaminski SS, Kang HS, Madabhushi VV, Murray J, Nance ML, Qureshi FG, Rubsam J, Stylianos S, Bertsimas DJ, Masiakos PT. Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years: The PEDSPINE II Study. JAMA Surg 2023; 158:1126-1132. [PMID: 37703025 PMCID: PMC10500431 DOI: 10.1001/jamasurg.2023.4213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 09/14/2023]
Abstract
Importance There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients. Objective To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model. Design, Setting, and Participants This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022. Exposure Blunt trauma. Main Outcomes and Measures Primary outcome was CSI. The primary and secondary objectives were predetermined. Results The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915). Conclusion and Relevance This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
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Affiliation(s)
- Casey M. Luckhurst
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston
| | | | - Rebeccah L. Brown
- Division of Pediatric Surgery at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Steven W. Bruch
- Division of Pediatric Surgery at University of Michigan Medical Center, Ann Arbor
| | - Nicole M. Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Paul D. Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - John M. Draus
- Division of Pediatric Surgery at Kentucky Children’s Hospital, Lexington
| | - Mary E. Fallat
- Division of Pediatric Surgery at Norton Children’s Hospital, Louisville, Kentucky
| | - Barbara A. Gaines
- Division of Pediatric Surgery at University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeffrey H. Haynes
- Department of Pediatric Surgery, Children’s Hospital of Richmond at Virginia Commonwealth University Health, Richmond
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery, and Surgical Critical Care at University of Southern California Medical Center, Los Angeles
| | - Saleem Islam
- Division of Pediatric Surgery at University of Florida Health, Gainesville
| | - Stephen S. Kaminski
- Department of Surgery at Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Hae Sung Kang
- Department of Surgery, Virginia Commonwealth University Health, Richmond
| | | | - Jason Murray
- Department of Surgery, University of Texas Health Tyler, Tyler
| | - Michael L. Nance
- Division of Pediatric Surgery at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Faisal G. Qureshi
- Division of Pediatric Surgery at Children’s Medical Center Dallas, Dallas, Texas
| | - Jeanne Rubsam
- Division of Pediatric Surgery at Morgan Stanley Children’s Hospital of New York-Presbyterian, New York
| | - Steven Stylianos
- Division of Pediatric Surgery at Morgan Stanley Children’s Hospital of New York-Presbyterian, New York
| | | | - Peter T. Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston
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Schömig F, Taheri N, Kalaf H, Muellner M, Becker L, Pumberger M. Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries. Arch Orthop Trauma Surg 2023; 143:2011-2017. [PMID: 35348873 PMCID: PMC10030453 DOI: 10.1007/s00402-022-04413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fractures of the thoracolumbar spine in children are rare. Consequently, classification systems providing detailed treatment recommendations as already established in adults are still lacking in the paediatric population. We aimed to evaluate the validity and reliability of the thoracolumbar injury classification and severity score system (TLICS) and the AOSpine injury score in paediatric patients presenting with a traumatic fracture of the thoracolumbar spine. MATERIALS AND METHODS Patients younger than 18 years presenting with a traumatic thoracolumbar fracture at a large academic trauma centre between 2010 and 2020 were included retrospectively. Demographic and clinical data were retrieved from electronic medical reports. The AOSpine injury score and TLICS were calculated using plain radiography, magnetic resonance imaging, and/or computed tomography. RESULTS Sixty patients with 167 fractures were included. Surgical treatment was performed in 14 patients. The mean AOSpine injury score was 1.49 ± 2.0, the mean TLICS was 1.32 ± 1.65. A significant correlation between the classification systems was found (Spearman r = 0.975, p < 0.001). Interrater reliability analysis revealed Kappa values of 0.868 for the TLICS and 0.860 for the AOSpine injury score (p < 0.001). Contingency table analysis showed a sensitivity of 1.00 and specificity of 0.94 for the AOSpine injury score and a sensitivity of 0.90 and specificity of 0.90 for the TLICS in predicting the performed treatment. CONCLUSIONS Our results confirm that the TLICS is a valid classification system for determining treatment decisions in paediatric patients and show slightly higher accuracy of the AOSpine injury score as well as high interrater reliabilities for both classification systems.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Nima Taheri
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Hussein Kalaf
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Chen J, Liang T, Hu Y, Ma Y, Huang S, Chen L, Jiang J, Li H, Chen T, Cen J, Liu C, Zhan X. Suitability of 3.5-mm screw for the atlas in children: a retrospective computed tomography analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1241-1250. [PMID: 35224674 DOI: 10.1007/s00586-022-07136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The growth and development of the atlas in children has not been studied to date using a large sample size. OBJECTIVE To study whether a 3.5-mm screw is suitable for the atlas in children, to explore the anatomical size and development of the atlas in 0-14-year-old children, and to provide morphological basis for lateral mass screw internal fixation. METHODS A Computed Tomography (CT) morphometric analysis was performed on 420 pediatric atlases. In the atlas, D1, D2, D3, D4, and α of the atlas lateral mass were measured. Statistical analysis was performed using one-way ANOVA and Students' t test. The least square method was used for the regression analysis of the change trend in anatomical structure. The curve with the greatest goodness of fit was used as the anatomic trend regression curve. RESULTS D1, D2, D3, and D4 generally showed an increasing trend with age. The ranges of averages of D1, D2, D3, D4, and α in 0-14 year-old children were as follows: 4.576-9.202 mm, 9.560-25.100 mm, 3.414-10.554 mm, 11.150-27.895, and 12.41°-20.97°, respectively. The trends of the fitting curves of L1 and L3 were power functions, and those of L2 and L4 were logarithmic curves. CONCLUSIONS CT examination could help in preoperative decision-making, and 3.5-mm screw was found to be suitable for lateral mass screw internal fixation in children aging 2 years and older. D1-D4 increased with age. This provided a certain reference to perform posterior atlantoaxial fusion in children and is of great significance to design posterior atlantoaxial screw in children.
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Affiliation(s)
- Jiarui Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Tuo Liang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Yajie Hu
- First Clinical Medical College, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Youliang Ma
- First Clinical Medical College, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Shengsheng Huang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Liyi Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jie Jiang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Hao Li
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Tianyou Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiemei Cen
- Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Chong Liu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Xinli Zhan
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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An S, Hyun SJ. Pediatric Spine Trauma. J Korean Neurosurg Soc 2022; 65:361-369. [PMID: 35462522 PMCID: PMC9082124 DOI: 10.3340/jkns.2021.0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022] Open
Abstract
Pediatric spine has growth potential with incomplete ossification, and also unique biomechanics which have important implications for trauma patients. This article intends to review various aspects of pediatric spine trauma including epidemiology, anatomy and biomechanics, and clinically relevant details of each type of injury based on the location and mechanism of injury. With the appropriate but not superfluous treatment, pediatric spine trauma patients can have better chance of recovery. Therefore, as a spine surgeon, understanding the general concept for each injury subtype together with the debate and progress in the field is inevitable.
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Sivakanthan S, Feroze A, Eaton J, Saigal R. Three Column Cervical Fracture-Dislocation in a 3-Year-Old Boy. Cureus 2022; 14:e23213. [PMID: 35449661 PMCID: PMC9012570 DOI: 10.7759/cureus.23213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/07/2022] Open
Abstract
Complete traumatic cervical fracture-dislocation with spinal cord transection in children is a rare entity with no evidence-based guidelines on management. The authors reviewed the literature for pediatric spinal cord injury and present the case of a 3-year-old with traumatic cervical fracture-dislocation and spinal cord transection who presented as a cervical-6 complete spinal cord injury (ASIA A). His other organ systems injured included liver, spleen, bowel, and abdominal aortic injury. The patient underwent halo placement for preoperative reduction followed by open reduction and internal fixation with posterior segmental instrumented fusion. Intraoperatively, the patient had motor evoked potential signals present below the level of his injury. Early postoperative follow-up demonstrated that, although his leg function did not improve, he did demonstrate improvement in upper extremities. This is a rare case of complete cervical spinal cord transection in a pediatric patient. We elected to manage this challenging case with initial external reduction and orthosis with a halo vest followed by acute posterior cervical fusion. Despite a cervical-6 injury level on clinical exam, there was electrographic evidence of function below that level on intraoperative neuromonitoring. Postoperatively the patient has recovered some lost function.
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Hasan S, Waheed M, Suhrawardy AK, Braithwaite C, Ahmed L, Zakko P, Khalil JG, Saleh ES. Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center. Cureus 2022; 14:e20995. [PMID: 35028239 PMCID: PMC8751658 DOI: 10.7759/cureus.20995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p=0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.
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Spine Fractures in Children and Adolescents—Frequency, Causes, Diagnostics, Therapy and Outcome—A STROBE-Compliant Retrospective Study at a Level 1 Trauma Centre in Central Europe. CHILDREN 2021; 8:children8121127. [PMID: 34943323 PMCID: PMC8700418 DOI: 10.3390/children8121127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
The aim of this study was to present the frequencies and characteristics of paediatric spine fractures, focusing on injury mechanisms, diagnostics, management, and outcomes. This retrospective, epidemiological study evaluated all patients aged 0 to 18 years with spine fractures that were treated at a level 1 trauma centre between January 2002 and December 2019. The study population included 144 patients (mean age 14.5 ± 3.7 years; 40.3% female and 59.7% male), with a total of 269 fractures. Common injury mechanisms included fall from height injuries (45.8%), with an increasing prevalence of sport incidents (29.9%) and a decreasing prevalence of road incidents (20.8%). The most common localisation was the thoracic spine (43.1%), followed by the lumbar spine (38.2%), and the cervical spine (11.8%). Initially, 5.6% of patients had neurological deficits, which remained postoperatively in 4.2% of patients. Most (75.0%) of the patients were treated conservatively, although 25.0% were treated surgically. A small proportion, 3.5%, of patients presented postoperative complications. The present study emphasises the rarity of spinal fractures in children and adolescents and shows that cervical spine fractures are more frequent in older children, occurring with a higher rate in sport incidents. Over the last few years, a decrease in road incidents and an increase in sport incidents in paediatric spine fractures has been observed.
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Beckmann NM, Cheekatla SK, Chinapuvvula NR, Zhang X, West OC. Accuracy of craniocervical measurements on CT for identifying partial or complete craniocervical ligament injuries in pediatric patients. Skeletal Radiol 2021; 50:159-169. [PMID: 32691127 DOI: 10.1007/s00256-020-03555-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the accuracy of craniocervical measurements for identifying craniocervical injuries and the frequency of subjective findings of craniocervical injuries on CT in pediatric patients. METHODS Case-controlled retrospective review of patients ≤ 16 years old with craniocervical junction injuries. Receiver operator curves were created for common craniocervical measurements on CT comparing patients with complete and partial craniocervical injuries to uninjured cohort. Frequency of subjective CT findings of craniocervical injury was assessed in the injured cohort. RESULTS For complete disruption injuries (CD) (n = 27), C1-C2 distance (AUC = 0.90, 95%CI = 0.83-0.97), atlanto-occipital distance (AUC = 0.95-0.98, 95%CI = 0.90-1.00), and basion-dens distance (AUC = 0.90, 95%CI = 0.82-0.98) had excellent accuracy diagnosing injury. Powers ratio (AUC = 0.85, 95%CI = 0.76-0.94) had good, basion-posterior axial line (AUC = 0.74, 95%CI = 0.61-0.86) fair, and atlanto-dental distance (AUC = 0.69, 95%CI = 0.57-0.82) poor accuracy. For partial disruption injuries (PD) (n = 21), basion-dens distance (AUC = 0.75, 95%CI = 0.62-0.88) had fair accuracy diagnosing injury. Powers ratio (AUC = 0.63, 95%CI = 0.47-0.79), C1-C2 distance (AUC = 0.60, 95%CI = 0.45-0.75), atlanto-dental distance (AUC = 0.55, 95%CI = 0.39 = 0.71), atlanto-occipital distance (AUC = 0.63-0.65, 95%CI = 0.47-0.81), and basion-posterior axial line (AUC = 0.60, 95%CI = 0.44-0.76) all had poor accuracy. Eighty-one percent (n = 22) of CD and 38% (n = 8) of PD patients had non-concentric atlanto-occipital joints. One hundred percent of CD patients had ≥ 1 soft tissue finding and eighty-one percent (n = 22) had ≥ 2 findings. Seventy-three percent (n = 16) of PD patients had ≥ 1 soft tissue finding. Eighty-six percent (n = 18) of PD patients had non-concentric atlanto-occipital joints and/or soft tissue findings. CONCLUSION Craniocervical measurements have poor accuracy for identifying craniocervical injuries in pediatric patients with incomplete craniocervical ligament disruption. Subjective findings of craniocervical injury are frequently present on CT in pediatric patients and can help increase sensitivity for identifying injury.
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Affiliation(s)
- Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.
| | - Suresh K Cheekatla
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
| | - Naga R Chinapuvvula
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
| | - Xu Zhang
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center, 6410 Fannin Street, UTPB 1100.08, Houston, TX, 77030, USA
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
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Ten Brinke JG, Slinger G, Slaar A, Saltzherr TP, Hogervorst M, Goslings JC. Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre. Eur J Trauma Emerg Surg 2020; 47:781-789. [PMID: 33108476 PMCID: PMC8187214 DOI: 10.1007/s00068-020-01520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. METHODS We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. RESULTS We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. CONCLUSION Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
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Affiliation(s)
- Joost G Ten Brinke
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
| | | | - Annelie Slaar
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Nunn C, Negus S, Lawrence T, Lecky F, Roland D. Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620939381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates. Methods A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016. Results The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units. Discussion This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury.
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Affiliation(s)
- Catherine Nunn
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Samantha Negus
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
| | | | - Fiona Lecky
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
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12
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Epidemiology and Imaging Classification of Pediatric Cervical Spine Injuries: 12-Year Experience at a Level 1 Trauma Center. AJR Am J Roentgenol 2020; 214:1359-1368. [DOI: 10.2214/ajr.19.22095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Gupta S, Hauser BM, Zaki MM, Xu E, Cote DJ, Lu Y, Chi JH, Groff M, Khawaja AM, Harris MB, Smith TR, Zaidi HA. Morbidity after traumatic spinal injury in pediatric and adolescent sports-related trauma. J Neurosurg Spine 2020; 32:642-648. [PMID: 31881536 PMCID: PMC7383358 DOI: 10.3171/2019.10.spine19712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sports injuries present a considerable risk of debilitating spinal injury. Here, the authors sought to profile the epidemiology and clinical risk of traumatic spinal injuries (TSIs) in pediatric sports injuries. METHODS The authors conducted a retrospective cohort analysis of pediatric patients who had experienced a sports-related TSI, including spinal fractures and spinal cord injuries, encoded in the National Trauma Data Bank in the period from 2011 to 2014. RESULTS Included in the analysis were 1723 cases of pediatric sports-related TSI, which represented 3.7% of all pediatric sports-related trauma. The majority of patients with TSI were male (81%), and the median age was 15 years (IQR 13-16 years). TSIs arose most often from cycling accidents (47%) and contact sports (28%). The most frequently fractured regions were the thoracic (30%) and cervical (27%) spine. Among patients with spinal cord involvement (SCI), the cervical spine was involved in 60% of cases.The average length of stay for TSIs was 2 days (IQR 1-5 days), and 32% of the patients required ICU-level care. Relative to other sports-related trauma, TSIs without SCI were associated with an increased adjusted mean length of stay by 1.8 days (95% CI 1.6-2.0 days), as well as the need for ICU-level care (adjusted odds ratio [aOR] 1.6, 95% CI 1.3-1.9). Also relative to other sports-related trauma, TSIs with SCI had an increased length of stay by 2.1 days (95% CI 1.8-2.6 days) and the need for ICU-level care (aOR 3.6, 95% CI 2.6-4.8).TSIs without SCI were associated with discharge to or with rehabilitative services (aOR 1.7, 95% CI 1.5-2.0), as were TSIs with SCI (aOR 4.0, 95% CI 3.2-4.9), both relative to other sports-related trauma. Among the patients with TSIs, predictors of the need for rehabilitation at discharge were having a laminectomy or fusion, concomitant lower-extremity injury, head injury, and thoracic injury. Although TSIs affected 4% of the study cohort, these injuries were present in 8% of patients discharged to or with rehabilitation services and in 17% of those who died in the hospital. CONCLUSIONS Traumatic sports-related spinal injuries cause significant morbidity in the pediatric population, especially if the spinal cord is involved. The majority of TSI cases arose from cycling and contact sports accidents, underscoring the need for improving education and safety in these activities.
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Affiliation(s)
- Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Blake M. Hauser
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Mark M Zaki
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Edward Xu
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - David J. Cote
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
- Channing Division of Network Medicine, Department of Medicine/Brigham and Women’s Hospital, Harvard Medical School/Boston/MA/USA
| | - Yi Lu
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - John H. Chi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Michael Groff
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Ayaz M. Khawaja
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
- Channing Division of Network Medicine, Department of Medicine/Brigham and Women’s Hospital, Harvard Medical School/Boston/MA/USA
| | - Mitchel B. Harris
- Department of Orthopedics/Massachusetts General Hospital, Harvard Medical School/Boston/MA/USA
| | - Timothy R. Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
| | - Hasan A. Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery/Harvard Medical School, Brigham and Women’s Hospital/Boston/MA/USA
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14
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Jarvers JS, Herren C, Jung MK, Blume C, Meinig H, Ruf M, Disch AC, Weiß T, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Matschke S, Kreinest M. [Pediatric spine trauma-Results of a German national multicenter study including 367 patients]. Unfallchirurg 2020; 123:280-288. [PMID: 32215669 DOI: 10.1007/s00113-020-00771-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In general, pediatric spinal injuries are rare. No reliable data on the epidemiology of spinal injuries in pediatric patients in Germany are available. Especially in pediatric patients, for whom the medical history, clinical examination and the performance of imaging diagnostics are difficult to obtain, all available information on a spinal injury must be taken into account. OBJECTIVE The aim of this study was to provide epidemiological data for pediatric patients with spinal trauma in Germany in order to enhance future decision-making for the diagnostics and treatment of these patients. MATERIAL AND METHODS Within the framework of a national multicenter study, data were retrospectively obtained from 6 German spine centers for 7 years between January 2010 and December 2016. In addition to the demographic data, the clinical databases were screened for specific trauma mechanisms, level of injury as well as accompanying injuries. Furthermore, diagnostic imaging and the treatment selected were also analyzed. RESULTS A total of 367 children (female: male = 1:1.2) with a total of 610 spinal injuries were included in this study. The mean age was 12 years (±3.5 years). The most frequent trauma mechanisms were falls from <3 m and traffic accidents. The imaging diagnostics were only rarely carried out with the child under anesthesia. Younger children (0-9 years old) suffered more injuries to the cervical spine, whereas injuries to the thoracic and lumbar spine were more frequently found in older children (>10 years old). The children frequently showed accompanying injuries to the head and the extremities. Accompanying spinal injuries mostly occurred in adjacent regions and only rarely in other regions. Around 75% of the children were treated conservatively. CONCLUSION The results were different from the knowledge obtained from adult patients with spinal trauma and describe the special circumstances for pediatric patients with spinal trauma. Despite certain limitations these facts may help to enhance future decision-making for the diagnostics and treatment of these patients.
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Affiliation(s)
- Jan-Sven Jarvers
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christian Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Matthias K Jung
- Zentrum für Wirbelsäulenchirurgie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - Christian Blume
- Klinik für Neurochirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Holger Meinig
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Deutschland
| | - Michael Ruf
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Deutschland
| | - Alexander C Disch
- UniversitätsWirbelsäulenzentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Thomas Weiß
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Hauke Rüther
- Zentrum für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Thomas Welk
- Abteilung für Radiologie und Neuroradiologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Deutschland
| | - Andreas Badke
- Abteilung für Wirbelsäulenchirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Oliver Gonschorek
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Christoph E Heyde
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, BG Unfallklinik Frankfurt, Frankfurt, Deutschland
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - Philipp Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, BG Unfallklinik Frankfurt, Frankfurt, Deutschland
| | - Holger Siekmann
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ulrich Spiegl
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Peter Strohm
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Deutschland
| | - Christoph Strüwind
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Stefan Matschke
- Praxis für Wirbelsäulenchirurgie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
| | - Michael Kreinest
- Zentrum für Wirbelsäulenchirurgie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Lykissas M, Gkiatas I, Spiliotis A, Papadopoulos D. Trends in pediatric cervical spine injuries in the United States in a 10-year period. J Orthop Surg (Hong Kong) 2020; 27:2309499019834734. [PMID: 30862255 DOI: 10.1177/2309499019834734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cervical spine fractures (CSFs) are potentially devastating injuries in pediatric population. Fortunately, these injuries are uncommon in pediatric patients. The purpose of this study was to determine the epidemiology, the risk factors, mechanisms of injury and to identify possible strategies for prevention. In addition, the aim of the current study was to compare CSF sustained in 2003 to CSF sustained in 2008 and 2013 so as to recognize the trend of pediatric CSFs in the United States. METHODS The National Electronic Injury Surveillance System was queried for CSF sustained in pediatric population up to 16 years of age for years 2003, 2008, and 2013. Outcomes of interest were patient characteristics (age and sex), causes of CSF, and mechanism of injury. RESULTS Eighty pediatric patients with CSF were identified. The average age was 10.5 years. Boys sustained significantly more CSF than girls. Statistically significant more CSF were occurred in children of 10-16 years than in children up to 9 years. Sports or recreational activities and home-related accidents were the predominant causes of CSF. Mechanisms of injury were age-related, with younger children sustaining CSF as a result of home-related accidents while adolescents commonly injured during sporting or recreational activities. In contrast to current data in literature, motor vehicle accidents were not a major cause of CSF. Comparing the years 2003, 2008, and 2013, statistically significant differences in the incidence of CSF were not found. CONCLUSIONS Our study confirms previous findings that adolescents who sustain CSF have higher incidence of sport or recreation-related accidents than younger patients who sustain commonly home-related accidents as a consequence of insufficient parental supervision. The perception that motor vehicle accidents comprise major cause of CSF appears not to be true.
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Affiliation(s)
- Marios Lykissas
- 1 Department of Paediatric Orthopaedics, Metropolitan Hospital, Athens, Greece
| | - Ioannis Gkiatas
- 2 Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Antonios Spiliotis
- 3 Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg, Saarland, Germany
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16
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[Development and first application testing of a new protocol for preclinical spinal immobilization in children : Assessment of indications based on the E.M.S. IMMO Protocol Pediatric]. Unfallchirurg 2019; 123:289-301. [PMID: 31768566 DOI: 10.1007/s00113-019-00744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND To protect the spine from secondary damage, spinal immobilization is a standard procedure in prehospital trauma management. Immobilization protocols aim to support emergency medicine personnel in quick decision making but predominantly focus on the adult spine; however, trauma mechanisms and injury patterns in adults differ from those in children and applying adult prehospital immobilization protocols to pediatric patients may be insufficient. Adequate protocols for children with spinal injuries are currently unavailable. OBJECTIVE The aim of this study was (i) to develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) to perform a first analysis of the quality of results if the protocol is used by emergency personnel. MATERIAL AND METHODS Based on a structured literature search a new immobilization protocol was developed. Analysis of the quality of results was performed by a questionnaire containing four case scenarios in order to assess correct decision making. The decision about spinal immobilization was made without and with the utilization of the protocol. RESULTS The E.M.S. IMMO Protocol Pediatric was developed based on the literature. The analysis of the quality of results was performed involving 39 emergency medicine providers. It could be shown that if the E.M.S. IMMO Protocol Pediatric was used, the correct type of immobilization was chosen more frequently. A total of 38 out of 39 participants evaluated the protocol as helpful. CONCLUSION The E.M.S. IMMO Protocol Pediatric provides decision-making support whether pediatric spine immobilization is indicated with respect to the cardiopulmonary status of the patient. In a first analysis, the E.M.S. IMMO Protocol Pediatric improves decision making by emergency medical care providers.
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17
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Barnes BC, Kamat PP, McCracken CM, Santore MT, Mallory MD, Simon HK, Sulton CD. Radiologic Imaging in Trauma Patients with Cervical Spine Immobilization at a Pediatric Trauma Center. J Emerg Med 2019; 57:429-436. [PMID: 31591076 DOI: 10.1016/j.jemermed.2019.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric trauma patients with cervical spine (CS) immobilization using a cervical collar often require procedural sedation (PS) for radiologic imaging. The limited ability to perform airway maneuvers while CS immobilized with a cervical collar is a concern for emergency department (ED) staff providing PS. OBJECTIVE To describe the use of PS and analgesia for radiologic imaging acquisition in pediatric trauma patients with CS immobilization. METHODS Retrospective medical record review of all trauma patients with CS immobilization at a high-volume pediatric trauma center was performed. Patient demographics, imaging modality, PS success, sedative and analgesia medications, and adverse events were analyzed. Patients intubated prior to arrival to the ED were excluded. RESULTS A total of 1417 patients with 1898 imaging encounters met our inclusion criteria. A total of 398 patients required more than one radiographic imaging procedure. The median age was 8 years (range 3.8-12.75 years). Computed tomography of the head was used in 974 of the 1898 patients (51.3%). A total of 956 of the 1898 patients (50.4%) required sedatives or analgesics for their radiographic imaging, with 875 (91.5%) requiring a single sedative or analgesic agent, and 81 (8.5%) requiring more than one medication. Airway obstruction was the most common adverse event, occurring in 5 of 956 patients (0.3%). All imaging procedures were successfully completed. CONCLUSION Only 50% of CS immobilized, nonintubated patients required a single sedative or analgesic medication for their radiologic imaging. Procedural success was high, with few adverse events.
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Affiliation(s)
- Brandi C Barnes
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Pradip P Kamat
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Courtney M McCracken
- Division of Biostatistics, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew T Santore
- Department of Pediatrics, Division of Pediatric Surgery, Department of Pediatric Trauma, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael D Mallory
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia
| | - Harold K Simon
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Carmen Denease Sulton
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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18
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Salerno S, Zerbo S, Vinci A, Lanzarone A, Baldino G, Procaccianti P, Lo Re G, Argo A. Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review. Med Leg J 2019; 87:151-155. [PMID: 31295056 DOI: 10.1177/0025817219848285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sergio Salerno
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Alessia Vinci
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonietta Lanzarone
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Gennaro Baldino
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Paolo Procaccianti
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
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The utility of magnetic resonance imaging in pediatric trauma patients suspected of having cervical spine injuries. J Trauma Acute Care Surg 2019; 87:1328-1335. [DOI: 10.1097/ta.0000000000002487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Hopper SM, McKenna S, Williams A, Phillips N, Babl FE. Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study. Emerg Med Australas 2019; 32:93-99. [PMID: 31317676 DOI: 10.1111/1742-6723.13351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES While cervical spine injuries (CSIs) are rare in the paediatric population, presentations to EDs with possible neck injuries are common. Based on a lack of Australian data we set out to determine how many possible injuries are clinically cleared, what imaging is used on the remainder and the incidence and characteristics of confirmed paediatric CSIs. METHODS We undertook a retrospective electronic medical record review of children <18 years with potential CSIs at a large tertiary paediatric trauma centre in Victoria, Australia over a 12 month period (annual census 87 000). For possible injuries we extracted key epidemiologic, imaging and short-term outcome data. RESULTS During the study period, a total of 617 patients with potential neck injuries were seen in the ED (617/87 000, 0.7%). The median age was 11 years. The most common mechanisms of injury were falls (41%), motor vehicle injuries (28%) and sports-related injuries (24%). Four hundred and fourteen of 617 (67%) underwent neck imaging (345/414, 83% plain radiograph; 100/414, 24% computed tomography; 7/414, 1.6% magnetic resonance imaging). Twenty-three of 617 (4.1%) had radiologically documented CSIs. Two required operative interventions for their neck injuries. CONCLUSION While two-thirds of children with potential CSIs undergo radiological evaluation, actual injuries are rare (<4%). These data suggest that there is a potential for improved targeting of cervical spine imaging for trauma. The development of a clinical decision tool may help reduce neck radiography.
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Affiliation(s)
- Sandy M Hopper
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stewart McKenna
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda Williams
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Natalie Phillips
- Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Franz E Babl
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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21
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Xun H, Lopez J, Darrach H, Redett RJ, Manson PN, Dorafshar AH. Frequency of Cervical Spine Injuries in Pediatric Craniomaxillofacial Trauma. J Oral Maxillofac Surg 2019; 77:1423-1432. [DOI: 10.1016/j.joms.2019.02.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
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22
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McAllister AS, Nagaraj U, Radhakrishnan R. Emergent Imaging of Pediatric Cervical Spine Trauma. Radiographics 2019; 39:1126-1142. [DOI: 10.1148/rg.2019180100] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aaron S. McAllister
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
| | - Usha Nagaraj
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
| | - Rupa Radhakrishnan
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
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23
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Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views. J Trauma Acute Care Surg 2019; 87:813-817. [PMID: 31162331 DOI: 10.1097/ta.0000000000002396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed CSI, children are often imaged excessively. In an attempt to decrease imaging of the cervical spine in children, we reviewed abnormal cervical radiographs (XR) to determine if the diagnosis of CSI could be made using a single-lateral cervical radiograph (LAT). Furthermore, we reviewed cervical computed tomography (CT) and magnetic resonance imaging (MRI) to ensure there were no missed CSI. METHODS Electronic medical records of trauma patients treated at a Level I Pediatric Trauma Center with abnormal XR findings followed by confirmatory CT or MRI between 2012 and 2017 were reviewed. All abnormal imaging on XR was compared with the LAT. In addition, all abnormal CTs and MRIs were reviewed to ensure there were no false negative XR. RESULTS A total of 3,735 XR were performed with 26 abnormal interpretations. All bony CSI were visualized on LAT. Confirmatory imaging found 13 (50%) were false positive and 13 (50%) were true positive. Secondary analysis of CT identified 12 injuries with prior XR; 8 of 12 LAT identifying the injury and 4 of 12 false positive on CT. Secondary analysis of MRI identified nine injuries with prior XR; 5 of 9 LAT identifying the injury. The four false-negative reads on MRI were ligamentous injuries. CONCLUSION Radiographs are commonly performed when evaluating CSI. In our population, initial assessment with a single LAT was equivalent to a multiple view XR. On secondary review, the only false-negative LAT reports were due to ligamentous injuries. This data suggests limiting exposure to LAT would accomplish the goal of reducing imaging without missing bony CSI and when ligamentous injury is suspected MRI should be the confirmatory study rather than CT. LEVEL OF EVIDENCE Diagnostic Test, level III.
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Gutierrez X, April M, Maddry J, Hill G, Becker T, Schauer S. Incidence of Pediatric Cervical Spine Injuries in Iraq and Afghanistan. South Med J 2019; 112:271-275. [PMID: 31050794 PMCID: PMC6485296 DOI: 10.14423/smj.0000000000000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cervical spine injuries in pediatric trauma patients are uncommon, and subsequently, proper diagnosis and the efficacy of spinal motion restriction in these patients remain a subject of contention. The aim of this study was to describe the incidence of cervical spine injuries in pediatric patients in Iraq and Afghanistan. Objective Military providers frequently treat civilians, including pediatric patients. Cervical spine injuries in pediatric trauma patients occur infrequently, with limited data on the incidence. The aim of this study was to describe the incidence of cervical spine injuries in pediatric patients in Iraq and Afghanistan. Methods We queried the Department of Defense Trauma Registry for all pediatric encounters from January 2007 to January 2016. We searched within that dataset for all cervical spine fractures. Results From January 2007 through January 2016 there were 3439 pediatric encounters. There were 36 subjects identified (1.0%) with a cervical spine fracture. Of those with a cervical spine fracture, 6 (17%) had a prehospital cervical collar placed, which did not improve survival to hospital discharge (collar, 66.7% vs no collar, 83.3%, P = 0.573). Of those with a cervical spine fracture, 6 (17%) had a documented spinal cord injury. The median age of subjects with a cervical spine fracture was 9.5 years and the majority (63.9%) were male. Most were injured by explosion (41.7%). The median composite injury score was higher in subjects with a cervical spine fracture compared with those without one (16.5 vs 10, P < 0.001). Subjects with a cervical spine fracture had longer lengths of stay in the intensive care unit (median 3 days vs 1, P = 0.012) and a trend toward worse survival to hospital discharge (80.6%, n = 29, vs 90.3%, n = 3074, P = 0.079). Conclusions Cervical spine injuries occurred infrequently in pediatric patients in Iraq and Afghanistan. When a fracture was present, almost one in five patients had spinal cord involvement. The pediatric prehospital literature would benefit from the development of a clinical decision tool to guide prehospital personnel as to when a cervical collar is indicated. Moreover, appropriate size equipment should be available when caring for host national civilians.
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Affiliation(s)
- Xandria Gutierrez
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
| | - Michael April
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
| | - Joseph Maddry
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
| | - Guyon Hill
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
| | - Tyson Becker
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
| | - Steven Schauer
- From the 59th Medical Wing, Joint Base San Antonio (JBSA) Lackland Air Force Base, the Department of Emergency Medicine, San Antonio Military Medical Center, JBSA, and Dell Children's Medical Center, Austin, Texas
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Galganski LA, Cox JA, Greenhalgh DG, Sen S, Romanowski KS, Palmieri TL. Cervical Spine Injury in Burned Trauma Patients: Incidence, Predictors, and Outcomes. J Burn Care Res 2019; 40:263-268. [PMID: 30801641 DOI: 10.1093/jbcr/irz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cervical spine injuries (CIs) carry significant morbidity and mortality; hence, cervical spine immobilization is used liberally in trauma patients, including burns. The incidence, predictors, and outcomes of CI in burn patients are unknown. A retrospective cohort from the National Trauma Data Bank between 2007 and 2012 included all burned patients with and without CI. Predictors of CI were identified by logistic regression. Outcomes with and without CI were compared with Wilcoxon rank sum test. A total of 94,964 patients were identified with burn injuries. The incidence of CI was 0.79% (n = 745). Mechanism of injury, age, and injury severity score (ISS) were significant predictors of CI. Odds of CI were 109.4 (95% CI: 61.2-195.3, P < .0001) for motor vehicle injury, 87.8 (95% CI: 47.0-164.0, P < .0001) for falls, 1.2 (95% CI: 0.6-2.3, P = .66) for fire/flame, and 2.4 (95% CI: 1.0-5.5, P < .0001) for explosion compared with reference of hot object/substance. For every year increase in age, there were 1.02 higher odds of CI (95% CI: 1.01-1.02, P < .0001). For each point increase in ISS, there were 1.05 higher odds of CI (95% CI: 1.04-1.05, P < .0001). Patients with CI had higher mortality (10.3% vs 2.9%, P < .0001), longer total length of stay (12.0 vs 2.0 days, P < .0001), intensive care unit length of stay (4.0 vs 0.0 days, P < .001), and ventilator days (1.0 vs 0.0 days, P < .0001). The incidence of CI in burn patients is low, especially when due to fire, flame, or scalds; however, CI is associated with higher mortality and worse outcomes.
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Affiliation(s)
- Laura A Galganski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Jessica A Cox
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
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Geuther M, Grassner L, Mach O, Klein B, Högel F, Voth M, Bühren V, Maier D, Abel R, Weidner N, Rupp R, Fürstenberg CH, Schneidmueller D. Functional outcome after traumatic cervical spinal cord injury is superior in adolescents compared to adults. Eur J Paediatr Neurol 2019; 23:248-253. [PMID: 30579697 DOI: 10.1016/j.ejpn.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Determining differences in neurological and functional outcome between adolescents and adults after acute traumatic spinal cord injury (SCI). DESIGN Retrospective, multi-center case-control study. METHODS 100 cases of patients under 18 years at accident with acute traumatic cervical SCI admitted to SCI centers participating in the European Multi-center study about SCI (EMSCI) between January 2005 and April 2016 were reviewed. According to their age at accident, age 13 to 17, patients were selected for the adolescent group. After applying in- and exclusion criteria 32 adolescents were included. Each adolescent patient was matched with two adult SCI patients for analysis. OUTCOME MEASURES ASIA Impairment scale (AIS) grade, neurological, sensory, motor level, total motor score, and Spinal Cord Independence Measure (SCIM III) total score. RESULTS Mean AIS conversion, neurological, motor and sensory levels as well as total motor score showed no significantly statistical difference in adolescents compared to the adult control group after follow up of 6 months. Significantly higher final SCIM scores (p < 0.05) in the adolescent group compared to adults as well as a strong trend for a higher gain in SCIM score (p < 0.061) between first and last follow up was found. CONCLUSIONS Neurological outcome after traumatic cervical SCI is not superior in adolescents compared to adults in this cohort. Significantly higher SCIM scores indicate more functional gain for the adolescent patients after traumatic cervical SCI. Juvenile age appears to be an independent predictor for a better functional outcome.
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Affiliation(s)
- Martina Geuther
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany.
| | - Lukas Grassner
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany; Department of Neurosurgery, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany; Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Strubergasse 22, 5020, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University Salzburg, Strubergasse 22, 5020 Salzburg, Austria
| | - Orpheus Mach
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Strubergasse 22, 5020, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University Salzburg, Strubergasse 22, 5020 Salzburg, Austria
| | - Florian Högel
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany; Institute of Biomechanics, Trauma Center Murnau and Paracelsus Medical University Salzburg, Strubergasse 22, 5020, Salzburg, Austria
| | - Maika Voth
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
| | - Volker Bühren
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Doris Maier
- Center for Spinal Cord Injuries, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Rainer Abel
- Spinal Cord Injury Center, Klinik Hohe Warte, Hohe Warte 8, 95445, Bayreuth, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Carl Hans Fürstenberg
- Spinal Cord Injury Center, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstr. 1, 76307, Karlsbad, Germany
| | | | - Dorien Schneidmueller
- Department of Pediatric Traumatology, Trauma Center, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany
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Janjua MB, Hwang SW, Samdani AF, Pahys JM, Baaj AA, Härtl R, Greenfield JP. Instrumented arthrodesis for non-traumatic craniocervical instability in very young children. Childs Nerv Syst 2019; 35:97-106. [PMID: 29959504 DOI: 10.1007/s00381-018-3876-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Occipitocervical instrumentation is infrequently required for stabilization of the axial and subaxial cervical spine in very young children. However, when it is necessary, unique surgical considerations arise in children when compared with similar procedures in adults. METHODS The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their experience with eight cases of young children (age less than or equal to 4 years) receiving occiput to axial or subaxial spine instrumentation and fixation. Diagnoses and indications included severe or secondary Chiari malformation, skeletal dysplastic syndromes, Klippel-Feil syndrome, Pierre Robin syndrome, Gordon syndrome, hemivertebra and atlantal occipitalization, basilar impression, and iatrogenic causes. RESULTS All patients underwent occipital bone to cervical spine instrumentation and fixation at different levels. Constructs extended from the occiput to C2 and T1 utilizing various permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combinations of autografts with bone matrix materials. All patients were placed in rigid cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular injuries occurred. CONCLUSION Instrumented arthrodesis can be a treatment option in very young children to address the non-traumatic craniocervical instability while reducing the need for prolonged external halo vest immobilization. Factors affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that may be unique to the toddler population.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA. .,Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA. .,Department of Orthopaedic and Neurological Surgery, University of Pennsylvania Hospital, Philadelphia, PA, USA.
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Ali A Baaj
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Mallory A, Stammen J, Zhu M. Cervical and thoracic spine injury in pediatric motor vehicle crash passengers. TRAFFIC INJURY PREVENTION 2019; 20:84-92. [PMID: 30715907 DOI: 10.1080/15389588.2018.1529412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Motor vehicle occupants aged 8 to 12 years are in transition, in terms of both restraint use (booster seat or vehicle belt) and anatomical development. Rear-seated occupants in this age group are more likely to be inappropriately restrained than other age groups, increasing their vulnerability to spinal injury. The skeletal anatomy of an 8- to 12-year-old child is also in developmental transition, resulting in spinal injury patterns that are unique to this age group. The objective of this study is to identify the upper spine injuries commonly experienced in the 8- to 12-year-old age group so that anthropomorphic test devices (ATDs) representing this size of occupant can be optimized to predict the risk of these injuries. METHODS Motor vehicle crash cases from the National Trauma Data Bank (NTDB) were analyzed to characterize the location and nature of cervical and thoracic spine injuries in 8- to 12-year-old crash occupants compared to younger (age 0-7) and older age groups (age 13-19, 20-39). RESULTS Spinal injuries in this trauma center data set tended to occur at more inferior vertebral levels with older age, with patients in the 8- to 12-year-old group diagnosed with thoracic injury more frequently than cervical injury, in contrast to younger occupants, for whom the proportion of cases with cervical injury outnumbered the proportion of cases with thoracic injury. With the cervical spine, a higher proportion of 8- to 12-year-olds had upper spine injury than adults, but a substantially lower proportion of 8- to 12-year-olds had upper spine injury than younger children. In terms of injury type, the 8- to 12-year-old group's injury patterns were more similar to those of teens and adults, with a higher relative proportion of fracture than younger children, who were particularly vulnerable to dislocation and soft tissue injuries. However, unlike for adults and teens, catastrophic atlanto-occipital dislocations were still more common than any other type of dislocation for 8- to 12-year-olds and vertebral body fractures were particularly frequent in this age group. CONCLUSIONS Spinal injury location in the cervical and thoracic spine moved downward with age in this trauma center data set. This shift in injury pattern supports the need for measurement of thoracic and lower cervical spine loading in ATDs representing the 8- to 12-year-old age group.
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Affiliation(s)
- Ann Mallory
- a Technical Services, Transportation Research Center Inc. , East Liberty , Ohio
- b Ohio State University
| | - Jason Stammen
- c Vehicle Research and Test Center, National Highway Traffic Safety Administration , East Liberty , Ohio
| | - Motao Zhu
- d Nationwide Children's Center for Injury Research and Policy , Columbus , Ohio
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Three-dimensional digitizing and anatomic study of lumbar vertebral canal and pedicle in children. Wideochir Inne Tech Maloinwazyjne 2018; 13:518-524. [PMID: 30524624 PMCID: PMC6280084 DOI: 10.5114/wiitm.2018.77554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Spinal pedicle screw internal fixation has been widely used in adult spine injury fixation. Due to being in a period of continuous growth and development, the spine of children at different ages shows different characteristics from adults in terms of anatomy, physiological function, and biomechanics. Furthermore, because the pedicle of children is small, has large anatomic variation, and has complex adjacent relationships, the surgical risk is extremely high. How to improve the screwing accuracy is the key to the success of children's pedicle internal fixation. Therefore, applying the concept of digitized and individualized screwing will be of great significance to children's pedicle screwing. Aim To investigate the morphologies, development patterns, and aging characteristics of the lumbar vertebral pedicle (LVP) in children aged 6-11 years, and to provide a theoretical basis for screw implantation and related biomechanical studies. Material and methods A total of 60 children aged 6-11 years were selected for the intergroup measurement and statistical analysis of their lumbar diameter, pedicle diameter, screw canal length (SCL), etc. Results Generally, the vertebral foramen diameter (ID), sagittal diameter (SD), pedicle width (PW), and SCL as well as the pedicle height (PH) exhibited an increasing trend with age and increasing vertebral sequence among children aged 6-11 years. Conclusions By observing the LVP in children using 3D digital reconstruction technology, the morphology of the spinal canal and pedicles at different lumbar segments showed obvious development patterns, and the best treatment protocol should be selected according to the LVP characteristics in clinical applications.
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Abstract
Acute onset of neurological signs and symptoms referable to the spine including difficulty walking, bowel and bladder dysfunction, and paresthesias in the extremities may be manifestations of pediatric spine emergency. Trauma is the most common etiology for a pediatric spinal emergency. Because a history of trauma is often available, the role of imaging involves detection of spinal injuries. Other pathologies such as infection, inflammation, vascular, and neoplasms may lead to pediatric spinal emergencies that also require imaging for assistance in determining the etiology and appropriate management.
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Affiliation(s)
- Katie Suzanne Traylor
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Stephen F Kralik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202.
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Abstract
OBJECTIVES Pediatric cervical spine injuries (CSIs) are rare but potentially fatal injuries. Plain radiographs (x-rays) and computed tomography (CT) are used to diagnose CSIs. Given concerns related to radiation exposure, the utility of x-rays in diagnosing CSIs compared with other forms of imaging must be examined. METHODS Patients younger than 19 years presenting with possible CSI to an urban tertiary care hospital who received imaging for possible CSI between January 1, 2011, and December 31, 2013, were included. The dose-length product was abstracted from the PACS system. Test performance for x-ray, CT, and MRI were calculated and effective radiation dose by age group was analyzed using the Kruskal-Wallis Test. RESULTS A total of 671 patient charts were reviewed, 574 children were included in the study cohort. Median age of enrolled children was 9.70 (interquartile range, 4.78-13.83) years; 42.5% were female. Test performance of x-ray, CT, and MRI to detect CSI were calculated. Cervical x-rays performed only slightly inferior to CT. Sensitivity was 83% (95% confidence interval [CI], 36-99%), and specificity was 97% (95% CI, 96%-99%) versus 100% (95% CI, 96%-100%) for CT. Median effective dose of radiation for cervical CTs was 4.51 mSv (interquartile range, 3.84-5.59 mSv). Median dose significantly increased with age (2.94-5.10 mSv, P < 0.001). CONCLUSIONS Plain radiographs were largely sufficient to screen for CSIs, indicating their utility as a screening tool for CSIs. The incidence of CSIs in our sample was similar to prior reports. The effective radiation dose delivered during pediatric head and cervical CTs were lower than previously published estimates.
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Ibebuike K, Roussot M, Watt J, Dunn R. Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review. Afr Health Sci 2018; 18:458-467. [PMID: 30602973 PMCID: PMC6306986 DOI: 10.4314/ahs.v18i2.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Paediatric cervical spine injuries are uncommon. Traumatic spondylolisthesis of the axis (TSA) is commonly encountered in the trauma setting. The management of TSA may be surgical or non-surgical. Decision making is quite challenging depending on patient presentation and nature of injury, and even more so in the paediatric age group. Objectives To present a case report highlighting the challenges in the management of TSA. Methods We present an 8 year old male, who sustained a bilateral C2 pars fracture with associated unusual C2-C3 posterior subluxation. Results Neuroradiological studies identified the fracture/subluxation of C2-C3 and revealed an intact but posteriorly displaced C2-C3 disc causing cord compression. An Extension Halter traction was initially commenced. This seemed to have worsened the patient's neck pains, and caused motor weakness and autonomic dysfunction. An anterior cervical discectomy and fusion was finally decided on and performed after evaluation and brainstorming by our spinal Unit. Intra-operative findings revealed separation of the C2-C3 disc from the C3 superior end plate which probably explains the unusual nature of the subluxation. Conclusion The case shows that surgical intervention as a primary management for TSA even in the paediatric age group is safe and also avoids risks inherent in conservative management.
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Meltzer JA, Stone ME, Reddy SH, Silver EJ. Association of Whole-Body Computed Tomography With Mortality Risk in Children With Blunt Trauma. JAMA Pediatr 2018; 172:542-549. [PMID: 29630685 PMCID: PMC6137533 DOI: 10.1001/jamapediatrics.2018.0109] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Although several studies have demonstrated an improvement in mortality for injured adults who receive whole-body computed tomography (WBCT), it is unclear whether children experience the same benefit. OBJECTIVE To determine whether emergent WBCT is associated with lower mortality among children with blunt trauma compared with a selective CT approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter cohort study was conducted from January 1, 2010, to December 31, 2014, using data from the National Trauma Data Bank on children aged 6 months to 14 years with blunt trauma who received an emergent CT scan in the first 2 hours after emergency department arrival. Data analysis was conducted from February 2 to December 29, 2017. EXPOSURES Patients were classified as having WBCT if they received CT head, CT chest, and CT abdomen/pelvis scans in the first 2 hours and as having a selective CT if they did not receive all 3 scans. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality in the 7 days after ED arrival. To adjust for potential confounding, propensity score weighting was used. Subgroup analyses were performed for those with the highest mortality risk (ie, occupants and pedestrians involved in motor vehicle crashes, children with a Glasgow Coma Scale score lower than 9, children with hypotension, and those admitted to the intensive care unit). RESULTS Of the 42 912 children included in the study (median age [interquartile range], 9 [5-12] years; 27 861 [64.9%] boys), 8757 (20.4%) received a WBCT. Overall, 405 (0.9%) children died within 7 days. After adjusting for the propensity score, children who received WBCT had no significant difference in mortality compared with those who received selective CT (absolute risk difference, -0.2%; 95% CI, -0.6% to 0.1%). All subgroup analyses similarly showed no significant association between WBCT and mortality. CONCLUSIONS AND RELEVANCE Among children with blunt trauma, WBCT, compared with a selective CT approach, was not associated with lower mortality. These findings do not support the routine use of WBCT for children with blunt trauma.
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Affiliation(s)
- James A. Meltzer
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York,Division of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Melvin E. Stone
- Division of Trauma, Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Srinivas H. Reddy
- Division of Trauma, Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ellen J. Silver
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Piatt J, Imperato N. Epidemiology of spinal injury in childhood and adolescence in the United States: 1997-2012. J Neurosurg Pediatr 2018; 21:441-448. [PMID: 29451452 DOI: 10.3171/2017.10.peds17530] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There has been no successful study of trends in population-based incidences of pediatric spinal injury in the United States. The goal of the current study was to develop robust data to correct this deficiency in contemporary trauma epidemiology. METHODS Discharges coded for spinal injury were extracted from the Kids' Inpatient Database for 1997, 2000, 2003, 2006, 2009, and 2012 for patients younger than 18 years. Childhood was defined as ages 0 through 14 years and adolescence as ages 15, 16, and 17 years. Denominator population data were taken from the website of the US Census. Annual incidences were estimated for hospitalization for spinal injury, spinal cord injury (SCI), and hospital death with spinal injury. Mechanistic and anatomical patterns of injury were studied. RESULTS The annual population-based incidences of hospitalization for spinal injury, SCI, and death with spinal injury trended downward from 1997 to 2012 for children and adolescents in the United States. Rates of SCI and death fell faster than overall hospitalization rates, suggesting lower thresholds for admission or greater diagnostic sensitivity to minor injuries over time. The incidence of hospitalization for spinal injury was roughly 8 times greater for adolescents than for children, and the incidence of SCI was roughly 6 times greater. Motor vehicle crash predominated among mechanisms for both children and adolescents, but penetrating injuries and sport injuries were more commonly associated with SCI. Lumbosacral injuries predominated in both children and adolescents, but injuries of the cervical spine were more commonly associated with SCI. CONCLUSIONS Further research is needed to identify the cause or causes of the observed decline in injury rates. Epidemiological data can inform and support prevention efforts.
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Affiliation(s)
- Joseph Piatt
- 1Division of Neurosurgery, Nemours Neuroscience Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware.,2Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Nicholas Imperato
- 3Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware
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Wang W, Huang X, Zhang Y, Deng G, Liu X, Fan C, Xi Y, Yu J, Ye X. Se@SiO 2 nanocomposites suppress microglia-mediated reactive oxygen species during spinal cord injury in rats. RSC Adv 2018; 8:16126-16138. [PMID: 35547361 PMCID: PMC9088170 DOI: 10.1039/c8ra01906a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/25/2018] [Indexed: 11/21/2022] Open
Abstract
Selenium (Se) is an essential trace element with strong antioxidant activity, showing a great prospect in the treatment of spinal cord injury (SCI). However, the narrow gap between the beneficial and toxic effects has limited its further clinical application. In this experiment, we used porous Se@SiO2 nanocomposites (Se@SiO2) modified by nanotechnology as a new means of release control to investigate the anti-oxidative effect in SCI. In vitro Se@SiO2 toxicity, anti-oxidative and anti-inflammatory effects on microglia were assayed. In vivo we investigated the protective effect of Se@SiO2 to SCI rats. Neurological function was evaluated by Basso, Beattie and Bresnahan (BBB). The histopathological analysis, microglia activation, oxidative stress, inflammatory factors (TNF-α, IL-1β and IL-6) and apoptosis were detected at 3 and 14 days after SCI. The favorable biocompatibility of Se@SiO2 suppressed microglia activation, which is known to be associated with oxidative stress and inflammation in vivo and in vitro. In addition, Se@SiO2 improved the rat neurological function and reduced apoptosis via caspase-3, Bax and Bcl-2 pathways in SCI. Se@SiO2 was able to treat SCI and reduce oxidative stress, inflammation and apoptosis induced by microglia activation, which may provide a novel and safe strategy for clinical application.
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Affiliation(s)
- Weiheng Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University No 415 Fengyang Road Shanghai 200003 China +86 021 81870950 +86 021 81885624 +86 021 81886807 +86 021 81870952
| | - Xiaodong Huang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University No 415 Fengyang Road Shanghai 200003 China +86 021 81870950 +86 021 81885624 +86 021 81886807 +86 021 81870952
| | - Yongxing Zhang
- Trauma Center of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine Shanghai 201620 China
| | - Guoying Deng
- Trauma Center of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine Shanghai 201620 China
| | - Xijian Liu
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science Shanghai 201620 China
| | - Chunquan Fan
- Department of Orthopaedic Surgery, The 175th Hospital of PLA, Orthopaedics Center of PLA, Affiliated Southeast Hospital of Xiamen University Zhangzhou Fujian Province PR China
| | - Yanhai Xi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University No 415 Fengyang Road Shanghai 200003 China +86 021 81870950 +86 021 81885624 +86 021 81886807 +86 021 81870952
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University No 415 Fengyang Road Shanghai 200003 China +86 021 81870950 +86 021 81885624 +86 021 81886807 +86 021 81870952
| | - Xiaojian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University No 415 Fengyang Road Shanghai 200003 China +86 021 81870950 +86 021 81885624 +86 021 81886807 +86 021 81870952
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Saleh S, Swanson KI, Bragg T. Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation. J Neurosurg Pediatr 2018; 21:16-20. [PMID: 29053055 DOI: 10.3171/2017.7.peds17105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical spine injuries are the most common spine injuries in the pediatric population. The authors present the youngest known patient who underwent cervical spine fusion to repair birth trauma-induced cervical fracture dislocation, resulting in spondyloptosis and spinal cord injury. A 2-week-old boy was found to have spondyloptosis and spinal cord injury after concerns arose from reduced movement of the extremities. The patient's birth was complicated by undiagnosed abdominal dystocia, which led to cervical distraction injury. At 15 days of age, the boy underwent successful C-5 corpectomy, with anterior C4-6 and posterior C2-7 arthrodesis, using an autologous rib graft for a C-5 fracture dislocation. MRI performed 2 weeks postoperatively revealed significant improvement in the alignment of the spinal canal. The patient was discharged from the hospital in a custom Minerva brace and underwent close follow-up in addition to occupational therapy and physical therapy. At the latest follow-up 4.5 years later, the patient was able to walk and ride a tricycle by himself. The authors describe the patient's surgery and the challenges faced in achieving successful repair and cervical spine stabilization in such a young patient. The authors suggest that significant neurological recovery after spinal cord injury in infants is possible with appropriate, timely, and interdisciplinary management.
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Affiliation(s)
- Sara Saleh
- 1Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kyle I Swanson
- 1Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,2Department of Neurosurgery, The Barrow Neurological Institute; and
| | - Taryn Bragg
- 1Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,3Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
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Figaji AA. Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care. Front Neurol 2017; 8:685. [PMID: 29312119 PMCID: PMC5735372 DOI: 10.3389/fneur.2017.00685] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023] Open
Abstract
General and central nervous system anatomy and physiology in children is different to that of adults and this is relevant to traumatic brain injury (TBI) and spinal cord injury. The controversies and uncertainties in adult neurotrauma are magnified by these differences, the lack of normative data for children, the scarcity of pediatric studies, and inappropriate generalization from adult studies. Cerebral metabolism develops rapidly in the early years, driven by cortical development, synaptogenesis, and rapid myelination, followed by equally dramatic changes in baseline and stimulated cerebral blood flow. Therefore, adult values for cerebral hemodynamics do not apply to children, and children cannot be easily approached as a homogenous group, especially given the marked changes between birth and age 8. Their cranial and spinal anatomy undergoes many changes, from the presence and disappearance of the fontanels, the presence and closure of cranial sutures, the thickness and pliability of the cranium, anatomy of the vertebra, and the maturity of the cervical ligaments and muscles. Moreover, their systemic anatomy changes over time. The head is relatively large in young children, the airway is easily compromised, the chest is poorly protected, the abdominal organs are large. Physiology changes—blood volume is small by comparison, hypothermia develops easily, intracranial pressure (ICP) is lower, and blood pressure normograms are considerably different at different ages, with potentially important implications for cerebral perfusion pressure (CPP) thresholds. Mechanisms and pathologies also differ—diffuse injuries are common in accidental injury, and growing fractures, non-accidental injury and spinal cord injury without radiographic abnormality are unique to the pediatric population. Despite these clear differences and the vulnerability of children, the amount of pediatric-specific data in TBI is surprisingly weak. There are no robust guidelines for even basics aspects of care in children, such as ICP and CPP management. This is particularly alarming given that TBI is a leading cause of death in children. To address this, there is an urgent need for pediatric-specific clinical research. If this goal is to be achieved, any clinician or researcher interested in pediatric neurotrauma must be familiar with its unique pathophysiological characteristics.
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Affiliation(s)
- Anthony A Figaji
- Neuroscience Institute, Division of Neurosurgery, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, South Africa
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Slaar A, Fockens MM, Wang J, Maas M, Wilson DJ, Goslings JC, Schep NWL, van Rijn RR. Triage tools for detecting cervical spine injury in pediatric trauma patients. Cochrane Database Syst Rev 2017; 12:CD011686. [PMID: 29215711 PMCID: PMC6486014 DOI: 10.1002/14651858.cd011686.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule (CCR). Both tools are proven to be accurate in deciding whether or not diagnostic imaging is needed in adults presenting for blunt trauma screening at the emergency department. However, little information is known about the accuracy of these triage tools in a pediatric population. OBJECTIVES To determine the diagnostic accuracy of the NEXUS criteria and the Canadian C-spine Rule in a pediatric population evaluated for CSI following blunt trauma. SEARCH METHODS We searched the following databases to 24 February 2015: CENTRAL, MEDLINE, MEDLINE Non-Indexed and In-Process Citations, PubMed, Embase, Science Citation Index, ProQuest Dissertations & Theses Database, OpenGrey, ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment, and the Aggressive Research Intelligence Facility. SELECTION CRITERIA We included all retrospective and prospective studies involving children following blunt trauma that evaluated the accuracy of the NEXUS criteria, the Canadian C-spine Rule, or both. Plain radiography, computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine, and follow-up were considered as adequate reference standards. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the quality of included studies using the QUADAS-2 checklists. They extracted data on study design, patient characteristics, inclusion and exclusion criteria, clinical parameters, target condition, reference standard, and the diagnostic two-by-two table. We calculated and plotted sensitivity, specificity and negative predictive value in ROC space, and constructed forest plots for visual examination of variation in test accuracy. MAIN RESULTS Three cohort studies were eligible for analysis, including 3380 patients ; 96 children were diagnosed with CSI. One study evaluated the accuracy of the Canadian C-spine Rule and the NEXUS criteria, and two studies evaluated the accuracy of the NEXUS criteria. The studies were of moderate quality. Due to the small number of included studies and the diverse outcomes of those studies, we could not describe a pooled estimate for the diagnostic test accuracy. The sensitivity of the NEXUS criteria of the individual studies was 0.57 (95% confidence interval (CI) 0.18 to 0.90), 0.98 (95% CI 0.91 to 1.00) and 1.00 (95% CI 0.88 to 1.00). The specificity of the NEXUS criteria was 0.35 (95% CI 0.25 to 0.45), 0.54 (95% CI 0.45 to 0.62) and 0.2 (95% CI 0.18 to 0.21). For the Canadian C-spine Rule the sensitivity was 0.86 (95% CI 0.42 to 1.00) and specificity was 0.15 (95% CI 0.08 to 0.23). Since the quantity of the data was small we were not able to investigate heterogeneity. AUTHORS' CONCLUSIONS There are currently few studies assessing the diagnostic test accuracy of the NEXUS criteria and CCR in children. At the moment, there is not enough evidence to determine the accuracy of the Canadian C-spine Rule to detect CSI in pediatric trauma patients following blunt trauma. The confidence interval of the sensitivity of the NEXUS criteria between the individual studies showed a wide range, with a lower limit varying from 0.18 to 0.91 with a total of four false negative test results, meaning that if physicians use the NEXUS criteria in children, there is a chance of missing CSI. Since missing CSI could have severe consequences with the risk of significant morbidity, we consider that the NEXUS criteria are at best a guide to clinical assessment, with current evidence not supporting strict or protocolized adoption of the tool into pediatric trauma care. Moreover, we have to keep in mind that the sensitivity differs among several studies, and individual confidence intervals of these studies show a wide range. Our main conclusion is therefore that additional well-designed studies with large sample sizes are required to better evaluate the accuracy of the NEXUS criteria or the Canadian C-spine Rule, or both, in order to determine whether they are appropriate triage tools for the clearance of the cervical spine in children following blunt trauma.
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Affiliation(s)
- Annelie Slaar
- WestfriesgasthuisDepartment of RadiologyMaelsonstraat 3HoornNoord HollandNetherlands1624 NP
| | - M M Fockens
- University of AmsterdamAcademic Medical CenterAmsterdamNetherlands
| | - Junfeng Wang
- Academic Medical CenterDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Mario Maas
- Academic Medical CenterDepartment of RadiologyUniversity of AmsterdamMeibergdreefAmsterdamNetherlands
| | - David J Wilson
- St Lukes HospitalDepartment of RadiologyLatimer RoadHeadingtonOxfordUKOX3 7PF
| | - J Carel Goslings
- Academic Medical CenterTrauma Unit, Department of SurgeryMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Niels WL Schep
- Academic Medical CenterDepartment of Surgery/Trauma UnitMeibergdreef 9AmsterdamNetherlands1105AZ
| | - Rick R van Rijn
- Academic Medical Center AmsterdamDepartment of RadiologyMeibergdreef 9AmsterdamNetherlands1105 AZ
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Farrokhi MR, Rezaei H, Farrokhi F. Anterior screw fixation in type II odontoid fracture in an 18-month-old girl: a case report and review of the literature. Br J Neurosurg 2017; 33:699-702. [DOI: 10.1080/02688697.2017.1409881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Majid Reza Farrokhi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Rezaei
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnaz Farrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Cassar-Pullicino VN, Leone A. Imaging in paediatric spinal injury. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408617725781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Paediatric spinal injury is rare and exhibits many unique features. Attending clinicians and radiologists often lack knowledge, expertise and experience in dealing with a potential injury to the paediatric spine. Within the paediatric age range itself there are different age-dependent mechanisms that can injure the paediatric spine. Moreover, the anatomical features and degree of osseous maturity of the developing paediatric spine determine the biomechanical characteristics which promote unique patterns of spinal injury in each paediatric age group. Methods An expert illustrated narrative review of the literature. Results Multiple factors make the imaging interpretation of the injured paediatric spine challenging. Each imaging modality has strengths and weaknesses in depicting spinal anatomy which vary with the type of spinal injury and age of the paediatric patient. Conclusions Attending doctors need to be familiar with the imaging appearances of the normal paediatric spine, its normal variants as well as the imaging features characteristics of paediatric spinal injury seen on radiographs, computed tomography and magnetic resonance imaging.
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Affiliation(s)
| | - Antonio Leone
- Institute of Radiology, School of Medicine, Catholic University, Rome, Italy
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Chen MY, Liu YT, Hsu WH. Changes in the axial orientation of the zygapophyseal joint in the subaxial cervical spine from childhood to middle-age, and the biomechanical implications of these changes. J Clin Neurosci 2017; 44:335-339. [DOI: 10.1016/j.jocn.2017.06.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
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An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.11526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Oh A, Sawvel M, Heaner D, Bhatia A, Reisner A, Tubbs RS, Chern JJ. Changes in use of cervical spine magnetic resonance imaging for pediatric patients with nonaccidental trauma. J Neurosurg Pediatr 2017; 20:271-277. [PMID: 28665242 DOI: 10.3171/2017.2.peds16644] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Past studies have suggested correlations between abusive head trauma and concurrent cervical spine (c-spine) injury. Accordingly, c-spine MRI (cMRI) has been increasingly used in radiographic assessments. This study aimed to determine trends in cMRI use and treatment, and outcomes related to c-spine injury in children with nonaccidental trauma (NAT). METHODS A total of 503 patients with NAT who were treated between 2009 and 2014 at a single pediatric health care system were identified from a prospectively maintained database. Additional data on selected clinical events were retrospectively collected from electronic medical records. In 2012, a clinical pathway on cMRI usage for patients with NAT was implemented. The present study compared cMRI use and clinical outcomes between the prepathway (2009-2011) and postpathway (2012-2014) periods. RESULTS There were 249 patients in the prepathway and 254 in the postpathway groups. Incidences of cranial injury and Injury Severity Scores were not significantly different between the 2 groups. More patients underwent cMRI in the years after clinical pathway implementation than before (2.8% vs 33.1%, p < 0.0001). There was also a significant increase in cervical collar usage from 16.5% to 27.6% (p = 0.004), and more patients were discharged home with cervical collar immobilization. Surgical stabilization occurred in a single case in the postpathway group. CONCLUSIONS Heightened awareness of potential c-spine injury in this population increased the use of cMRI and cervical collar immobilization over a 6-year period. However, severe c-spine injury remains rare, and increased use of cMRI might not affect outcomes markedly.
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Affiliation(s)
| | - Michael Sawvel
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta
| | - David Heaner
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta
| | - Amina Bhatia
- Pediatric Surgery, Emory University, Atlanta; and.,Children's Physician Group, Pediatric Surgery, Children's Healthcare of Atlanta, Georgia; and
| | - Andrew Reisner
- Neurosurgery, Emory University School of Medicine.,Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta
| | - R Shane Tubbs
- Department of Neurosurgery, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Joshua J Chern
- Neurosurgery, Emory University School of Medicine.,Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta
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Safir S, Rasouli J, Steinberger J, Skovrlj B, Doshi A, Margetis K, Ghatan S. Absent congenital cervical pedicle nearly misdiagnosed as a facet dislocation: A case report. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2017; 9:20-23. [PMID: 28713667 PMCID: PMC5508796 DOI: 10.1016/j.inat.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cervical spinal injury encompasses up to 1.5% of all pediatric injuries. Children, and more specifically infants, are a difficult subset of patients to obtain neurological exam in the setting of trauma, thus necessitating the use of cervical X-rays, CT scans, and MRI imaging. Case description A healthy, 15-month-old boy had an unwitnessed fall down a flight of stairs and received a CT scan of the head and cervical spine in the emergency department due to cephalohematoma and mechanism of injury. The patient was initially diagnosed with a unilateral facet dislocation but after additional imaging and rigorous interdisciplinary discussions, the patient was correctly diagnosed with a congenitally absent left C5 pedicle. Surgical intervention was not pursued and the patient was discharged home with close follow up. Conclusion In the acute trauma setting, congenital absent cervical pedicle can be difficult to differentiate from unilateral facet dislocation and may require the use of advanced imaging and close communication between the neurosurgery and radiology departments. Given the high morbidity and mortality involved in the repair of facet dislocation in a child, it is crucial to maintain high degree of clinical suspicion for absent spinal pedicle. In this case, the patient nearly underwent surgical intervention, but was ultimately able to be discharged home with no symptoms or deficits after correct diagnosis.
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Affiliation(s)
- Scott Safir
- Department of Surgery, Mount Sinai Health System, New York, NY 10029, United States
| | - Jonathan Rasouli
- Department of Neurological Surgery, Mount Sinai Health System, New York, NY 10029, United States
| | - Jeremy Steinberger
- Department of Neurological Surgery, Mount Sinai Health System, New York, NY 10029, United States
| | - Branko Skovrlj
- Department of Neurological Surgery, Mount Sinai Health System, New York, NY 10029, United States
| | - Amish Doshi
- Department of Radiology, Mount Sinai Health System, New York, NY 1029, United States
| | - Konstantinos Margetis
- Department of Neurological Surgery, Mount Sinai Health System, New York, NY 10029, United States
| | - Saadi Ghatan
- Department of Neurological Surgery, Mount Sinai Health System, New York, NY 10029, United States
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Impact of Glycemic Control on Morbidity and Mortality in Adult Idiopathic Scoliosis Patients Undergoing Spinal Fusion. Clin Spine Surg 2017; 30:E974-E980. [PMID: 27764054 DOI: 10.1097/bsd.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective analysis of administrative database. OBJECTIVE To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery. SUMMARY OF BACKGROUND DATA Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery. Previous studies may have reported higher than true rates of complications for controlled diabetic patients, who are the majority of diabetic patients. MATERIALS AND METHODS The Nationwide Inpatient Sample was queried from years 2002 to 2011. We extracted idiopathic scoliosis patients older than 45 years of age that received spinal fusion and analyzed complications and outcomes variables among 3 cohorts: nondiabetic patients, controlled diabetics, and uncontrolled diabetics. Multivariate analyses were used to assess whether glycemic control was a risk factor for adverse postoperative outcomes. RESULTS Controlled diabetics had significantly increased rates of acute renal failure (ARF), while uncontrolled diabetics had significantly increased rates of acute postoperative hemorrhage. In multivariate analyses controlling for patient factors and comorbidities, controlled DM was found to be an independent predictor of ARF [odds ratio (OR), 1.863; 95% confidence interval (CI), 1.346-2.579; P=0.0002), and uncontrolled DM was found to be a significant risk factor for acute postoperative hemorrhage (OR, 2.182; 95% CI, 1.192-3.997; P=0.0115), ARF (OR, 4.839; 95% CI, 1.748-13.392; P=0.0024), deep vein thrombosis (OR, 5.825; 95% CI, 1.329-25.522, P=0.0194) and in-patient mortality (OR, 8.889; 95% CI, 1.001-78.945; P=0.0499). CONCLUSIONS Controlled DM was found to be a risk factor for ARF in adult idiopathic scoliosis patients undergoing spinal fusion surgery, while uncontrolled DM was shown to be a risk factor for postoperative hemorrhage, ARF, deep vein thrombosis, and mortality. The present study provides valuable data for better informed consent for patients with diabetes considering surgery for idiopathic scoliosis. LEVEL OF EVIDENCE Level III.
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Comparison of the GlideScope Cobalt® and Storz DCI® Video Laryngoscopes in Children Younger Than 2 Years of Age During Manual In-Line Stabilization: A Randomized Trainee Evaluation Study. Pediatr Emerg Care 2017; 33:467-473. [PMID: 26785097 DOI: 10.1097/pec.0000000000000607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Video laryngoscopy facilitates tracheal intubation during manual in-line stabilization in adults, but it is not clear whether these findings translate to children. We compared trainee intubation times obtained using the GlideScope Cobalt® and Storz DCI® video laryngoscopes versus direct laryngoscopy in young children with immobilized cervical spines. METHODS Ninety-three children younger than 2 years underwent laryngoscopy with manual in-line stabilization using direct laryngoscopy, GlideScope Cobalt® video laryngoscopy, or Storz DCI® video laryngoscopy. Laryngoscopists were anesthesiology trainees in postgraduate training year of 3 or more. Total time to successful intubation (TTSI), best glottic view, and maximum degrees of neck deviation were recorded. An intubation time difference longer than 10 seconds was defined as clinically significant. RESULTS Data are reported as median; 95% confidence interval. The TTSI was similar among groups although Storz times were longer (median, 33.3 seconds; 95% confidence interval, 26.2-43.3 seconds) when compared to direct laryngoscopy (median, 23.3 seconds; 95% confidence interval, 20.7-26.5 seconds; P = 0.02). Obtaining a grade 1 Cormack-Lehane glottic view was less likely with direct laryngoscopy (P = 0.002). Maximum degrees of neck deviation were: Storz (median, 2.0; 95% confidence interval, 1.2-2.8), GlideScope (median, 2.0; 95% confidence interval, 1.4-2.6), and direct laryngoscopy (median, 1.9; 95% confidence interval, 1.2-2.1; P = 0.48). CONCLUSIONS Trainees were able to safely perform tracheal intubation in children younger than 2 years using any of the studied laryngoscopes, although Storz use resulted in a longer TTSI when compared to direct laryngoscopy. Video laryngoscopy may enhance best Cormack-Lehane glottic view during manual in-line cervical spine immobilization, but additional technical skills are needed to successfully complete tracheal intubation.
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Wang X, Shi J, Zhang S, Zhang Z, Li X, Li Z. Pediatric Lumbar Pedicle Screw Placement Using Navigation Templates: A Cadaveric Study. Indian J Orthop 2017; 51:468-473. [PMID: 28790477 PMCID: PMC5525529 DOI: 10.4103/0019-5413.209955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pedicle screw technique is commonly used treatment of adult spinal trauma, tumor, degeneration. The application of pedicle screws is very challenging in children because children have a fast growing spine and spinal pedicle morphology of children and adult has large difference. 3 D reconstruction individual navigation templates improve the success rate of pediatric pedicle screw system. This study is aimed to provide a precise method for lumbar spine pedicle screw placement in children using computer-aided design and rapid prototyping technology. MATERIALS AND METHODS Computed tomography (CT) scans of cadaver specimens of 4 children were obtained, and the raw data were reconstructed using three-dimensional reconstruction software. Pedicle screws were placed using the conventional method or by using individually designed navigation templates based on the principles of reverse engineering and rapid prototyping technology. RESULTS We evaluated the accuracy of the pedicle screws placed using the two methods by CT scan. Ten navigation templates were designed for placement of 20 lumbar pedicle screws in the navigation group, and CT scan confirmed that all the screws were placed accurately in the corresponding pedicle. Conversely, of the 20 lumbar pedicle screws placed using the conventional method, 3 screws perforated the pedicle. The findings showed that lumbar pedicle screw placement was successful using navigation templates in children. CONCLUSIONS This technique is simple, easy to master, and allows personalized screw placement, thus providing a new and feasible method for lumbar pedicle screw placement in children.
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Affiliation(s)
- Xing Wang
- Department of Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
- Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
| | - Jun Shi
- Department of Physiology, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
| | - Shojie Zhang
- Department of Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
- Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
| | - Zhifeng Zhang
- Department of Joint Surgery, The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
| | - Xiaohe Li
- Department of Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
| | - Zhijun Li
- Department of Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
- Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China
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Shah K, Tikoo A, Kothari MK, Nene A. Current Concepts in Pediatric Cervical Spine Trauma. Open Orthop J 2017; 11:346-352. [PMID: 28603566 PMCID: PMC5447926 DOI: 10.2174/1874325001711010346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 07/10/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Pediatric spinal trauma is rare and challenging entity. Although cervical spine is commonly affected, it is often missed on routine imaging investigations. Therefore better understanding of growing spine and its patho-physiology is crucial. Methods: Articles related to pediatric cervical trauma were searched on Pubmed and other online research data banks. We have summarized unique anatomy of pediatric spine, investigations followed by common injury patterns, their diagnostic challenges and management. Results: Immature spine follows typical injury patterns, so thorough knowledge of its presentation should be known. Primary physicians should be able to perform initial assessment based on clinical examination and investigations for early diagnosis. High index of suspicion and strategic approach leads to early diagnosis and prevents further morbidity and mortality. Conclusion: Spinal injuries in children are rare and typical. They are often missed and can have fatal consequences. Thorough understanding of pediatric anatomy and injury patterns helps in early diagnosis.
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Affiliation(s)
- Kunal Shah
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Agnivesh Tikoo
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Manish K Kothari
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Abhay Nene
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
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Sesia SB, Prüfer F, Walther M, Studer D. Delayed diagnosis of fractured anterior arch of the atlas in a young child. BMJ Case Rep 2017; 2017:bcr-2016-214472. [PMID: 28073868 DOI: 10.1136/bcr-2016-214472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 2-year-old girl fell off a bunk bed onto a parquet floor. She immediately reported neck pain and presented with muscle spasm and limited motion of the cervical spine (C-spine). Plain X-rays of the C-spine showed no osseous lesion. Owing to persisting pain and limited motion in the neck, MRI of the C-spine was obtained which revealed intact ligaments and cervical spinal cord, as well as soft tissue swelling in front of the anterior arch of the atlas. Subsequent CT of the C-spine confirmed a complete, undisplaced fracture of the anterior arch of the atlas (Gehweiler type I fracture). A Minerva cast was applied for 2 months, followed by a soft cervical collar. Persistent neck pain and limited range of motion of the neck after a fall may be indicative of atlas fracture that should be ruled out by CT.
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Affiliation(s)
- Sergio B Sesia
- Department of Pediatric Surgery, University Children's Hospital (UKBB), Basel, Switzerland
| | - Friederike Prüfer
- Department of Paediatric Radiology, University Children's Hospital, Basel, Switzerland
| | - Michael Walther
- Department of Emergency, University Children's Hospital, Basel, Switzerland
| | - Daniel Studer
- Department of Orthopedic and Spine Surgery, University Children's Hospital, Basel, Switzerland
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Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls. Skeletal Radiol 2016; 45:1607-1617. [PMID: 27650073 DOI: 10.1007/s00256-016-2481-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/16/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma.
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