P0105 - Pediatric thoracolumbar spinal injuries in United States trauma centers

Purpose: Injuries are the leading cause of morbidity and mortality in children ages 1 to 18 years. Thoracolumbar (TL) spinal injuries are critical because they can have devastating neurologic sequela with significant life changing outcomes. Unlike cervical spinal injuries, there is inadequate and variable data about TL spinal injuries in the pediatric population. The purpose of this study was to characterize TL spinal injuries among pediatric patients evaluated in US trauma centers. Understanding factors associated with TL spinal injuries could improve management and prevention of these injuries.

Methods: This was a retrospective cohort study of the National Trauma Data Bank, the largest de-identified registry of pediatric and adult trauma centers in the US. Inclusion criteria included patients aged 1 to 18 years with a thoracic or lumbar spinal injury sustained by blunt trauma during calendar years 2011 through 2016. Exclusion criteria included death prior to arrival or penetrating trauma. The data was abstracted, and missing data was addressed by imputations using mice package in R software. Data was analyzed in both SPSS, version 26 and SAS, version 9.4 for descriptive statistics and polytomous logistic regressions to determine odds ratios and confidence intervals. The polytomous logistic regression model was adjusted for age, gender, race, payer, GCS, mechanism of injury and predicted the injury type.

Results: A total of 24,496 patients were included in the study. The majority of subjects who sustained TL spinal injuries were 16-17 years old (46.4%), male (55.7%), Caucasian (74.5%) and had private insurance (56.1%) (Table 1). Isolated bone injury (79.2%) was the most common injury type. The injuries were largely unintentional (98.4%) and from a motor vehicle collision (MVC) (57.6%). Mechanism of injury and age were significant in predicting injury type (Table 2). Injury due to fall was most often seen in children aged 6-12 years and MVC/transportation-related injuries were most often seen in adolescents aged 16-17 years. A fall was more likely than an MVC to result in a cord injury (1.15 [1.02-1.29]), disc injury (1.47 [1.12-1.93]), and strain injury (1.20 [1.09-1.33]) when compared to a bone injury. Younger children (1-5 years old) were more likely than teenagers (16-17 years old) to present with cord injury (2.47 [2.10-2.91]) and disc injury (2.87 [1.94-4.24]) when compared to bone injuries.

Conclusions: To our knowledge, this is the largest pediatric TL spinal study. The most common mechanism of injury was an MVC and typically occurred in adolescent Caucasian males. Spinal cord injury was most frequently due to falls and seen in children aged 1-5 years. Pediatric TL spinal injury prevention should highlight motor vehicle and fall safety. Ongoing analyses will further characterize target populations to consider for prevention efforts.