Citation

Sarwahi V, Atlas AM, Galina J, Satin A, Dowling TJ, Hasan S, Amaral TD, Lo Y, Christopherson N, Prince J. Spine 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0000000000004072

PMID

unavailable

Abstract

STUDY DESIGN: Database Study.

OBJECTIVE: The purpose of this study was to use a large, nationwide database to determine prevalence of pediatric spine fractures in the US, associated injuries, mechanisms of injury, use of safety devices and mortality rates. SUMMARY OF BACKGROUND DATA: Spinal fractures account for 1- 2% of pediatric injuries. However, they are associated with significant co-morbidities and complications. Motor vehicle accidents (MVA) are most responsible for increased incidence observed.

METHODS: Retrospective review of NTDB between 2009-2014 (analysis in 2019), for all vertebral fractures in patients under 18 years of age. Sub-analysis included those in MVAs where protective device use data was available. Patient demographics, mechanism (MOI), geographical and anatomical region of injury, concomitant musculoskeletal/organ injury, protective device usage, hospital length of stay, surgical procedures and mortality were all analyzed.

RESULTS: 34,563 patients with 45,430 fractured vertebrae included. Median age was 15 years. Most fractures (63.1%) occurred in patients aged 15-17, most frequent MOI was MVA (66.8%), most common geographic location was the South (38%). Males sustained more spine fractures than females, overall (58.4%vs41.6%;p < 0.001) and in MVAs (54.4%vs45.6%;p < 0.001). Those in MVAs wearing seatbelts had lower odds of cranial (29.6%vs70.4%;OR = 0.85,95%CI:0.82-0.89;p < 0.001) and thoracic (30.1%vs69.9%;OR = 0.88,95%CI:0.84-0.91;p < 0.001) organ injury, multi-vertebral (30%vs70%;OR = 0.78,95%CI:0.73-0.83;p < 0.001) and concomitant non-vertebral fractures (30.9%vs69.1%;OR = 0.89,95%CI:0.73-0.83;p < 0.001), and 21% lower odds of mortality (29.3%vs70.7%;OR = 0.79,95%CI:0.66-0.94;p = 0.009). Over 70% of drivers were not restrained during MVA, with majority of seatbelt violations incurred by males, ages 15-17, in the South.

CONCLUSION: Over 60% of pediatric spinal fractures occur in children ages 15-17, coinciding with the beginning of legal driving. MVA is most common cause and has significant association with morbidity/mortality. Nearly 2/3 pediatric spinal fractures sustained in MVAs occurred without seatbelts. Absence of seatbelts associated with more than 20% greater odds of mortality. Ensuring new drivers wear protective devices can greatly reduce morbidity/ mortality associated with MVA.Level of Evidence: 3.

Language: en