Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern

Abstract

Aim The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36 months with inflicted trauma. Methods An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36 months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48 h. Variables were compared by t-test and Fisher-exact test. Results There were 53 children (median age: five months; range: 1–35 months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p = 0.02), shaking (p = 0.04), lower Glasgow coma score (GCS) (p = 0.01), brain infarcts (p = 0.01), and hypoxic/ischemic injury (p = 0.01) were associated with c-spine injury. One with AOD died. Six had significant disability. Conclusion For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging. Level of evidence Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis.