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Pediatric cervical spine injuries are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children. The objective of this study was to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center.
Methods and Materials
After institutional review board approval, an analysis was performed of all admissions to a single level 1 trauma center pediatric maxillofacial trauma, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine fracture. Data was abstracted to include demographic, mechanism and clinical outcomes data. Statistical analysis using chi-square and Mann-Whitney U tests were performed to compare these groups.
Results
There were 1277 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.6%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age (14.0 v 12.2 years, p = 0.02) and penetrating mechanism (13.8 v 5.5% p<0.01). All penetrating facial injuries associated with cervical spine injuries were secondary to gunshot wounds. Cervical spine injuries were associated with concomitant traumatic brain injuries (p<0.01) and skull fractures (p<0.01). Patients with spine injuries were more like to experience a longer length of stay (11.9 v 5.2 days, p<0.01) and death (12.5% v 3.1%, p<0.01).
Conclusions
Our database demonstrated a 6% incidence of pediatric cervical spine injuries in patients with known maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Specifically, the incidence of spine trauma in our database was highest with gunshot wounds causing maxillofacial trauma. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out. Additionally, clinicians should maintain a high index of suspicion for cervical spine injuries in pediatric patients with trauma to the head and neck.