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. 2015 Jun;9(3):171-5.
doi: 10.1007/s11832-015-0657-9. Epub 2015 May 8.

Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients

Amit Jain  1 , Jaysson T Brooks, Sandesh S Rao, Michael C Ain, Paul D Sponseller
Affiliations

Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients

Amit Jain et al. J Child Orthop. 2015 Jun.

Abstract

Background: Cervical spine fractures with spinal cord injury (CFSCI) can be devastating. We describe the epidemiology of children and adolescents with CFSCI.

Methods: Using the Nationwide Inpatient Sample (NIS) database, we identified 4418 patients (≤18 years old) who had CFSCI from 2000 through 2010. Outcomes of interest were patient characteristics (age, sex), injury characteristics [fracture location, spinal cord injury (SCI) pattern], economic variables (duration of hospital stay, total hospital charges), and mortality.

Results: Upper cervical fractures (UCFs) occurred half as often (31.4 %) as lower cervical fractures (LCFs; 68.8 %). Among patients <8 years old, 73.6 % had UCFs; among patients ≥8 years old, 72.3 % had LCFs. Overall, 68.7 % had incomplete SCI, 22.4 % had complete SCI, 6.6 % had central cord syndrome, and 2.3 % had anterior cord syndrome. Patients with complete SCI had the longest hospital stays and highest hospital charges. The overall in-hospital mortality rate was 7.3 %, with a sixfold higher rate in patients <8 (30.6 %) vs. those ≥8 (5.1 %) years old (p < 0.001). There was a threefold higher mortality rate in patients with upper (13.5 %) vs. lower (4.3 %) cervical fractures (p < 0.001). Patients with complete SCI had a 1.85-fold higher mortality rate than patients with other cord syndromes (p < 0.001).

Conclusions: Patients <8 years old were more likely than older patients to sustain UCFs. Patients with UCFs had a significantly higher mortality rate than those with LCFs. Patients with complete SCI had the longest duration of hospital stay and highest hospital charges and in-hospital mortality rate.

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Figures

Fig. 1
Fig. 1
Age distribution in 4418 patients with cervical spine fractures with spinal cord injury. National Inpatient Sample, 2000–2010
Fig. 2
Fig. 2
Upper cervical fractures (UCFs) are more common in patients <8 years old. At ≥8 years old, lower cervical fractures become more common. National Inpatient Sample, 2000–2010
Fig. 3
Fig. 3
In-hospital mortality rates among 4418 patients with cervical spine fractures with spinal cord injury by age group. National Inpatient Sample, 2000–2010
See this image and copyright information in PMC

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