The clinical presentation of pediatric thoracolumbar fractures.
BACKGROUND
The initial evaluation of suspected pediatric thoracolumbar fractures can be challenging. We aimed to describe the clinical presentation of thoracolumbar fractures in children and adolescents including an evaluation of physical examination sensitivity and specificity, and a description of injury severity and disposition.


METHODS
This was a case control, retrospective study. All patients with radiologically proven fractures (January 1997-June 2001) were studied. Data were collected in a standardized fashion, as part of the trauma registry, and extracted for retrospective analysis, including: patient demographics, clinical acuity, mechanism of injury, injury scores, and length of stay.


RESULTS
There were 96 patients with thoracolumbar fractures (TLF) and 96 control patients (NTLF) enrolled in our study. The groups were significantly different (p < 0.05) regarding several variables including: median age (11 years TLF, 7.5 years NTLF), Revised Trauma Score (7.84 for TLF, 7.55 for NTLF), need for hospital admission (60% TLF, 86% NTLF), PICD admission (23% TLF, 56% NTLF), general surgical procedures (18%TLF, 34% NTLF), Injury Severity Score (8 TLF, 10NTLF). Patients were not different regarding gender, Glasgow Coma Scale, hospital days, or mortality. An abnormal thoracolumbar spine examination was noted in 77 TLF patients and 20 NTLF patients, the sensitivity was 87% (95% CI: 78-93) and the specificity was 75% (95% CI: 65-84). The most common thoracolumbar spine abnormality was tenderness.


CONCLUSIONS
Thoracolumbar spine fractures are more common in older children and adolescents. The physical examination has a sensitivity of 87% in this retrospective analysis. Mortality was low and few patients required operative intervention for a thoracolumbar fracture.
Santiago
Rafael
R
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT 84102, USA.
Guenther
Elisabeth
E
Carroll
Kristen
K
Junkins
Edward P
EP
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries*; D015599:Trauma Severity Indices