title: The epidemiology of childhood and adolescent traumatic spinal cord injury in the United States: 2007-2010.
abstract: The burden of acute traumatic spinal cord injury (TSCI) among U. S. children and adolescents was last described over a decade ago using inpatient data. We describe cumulative incidence, mortality, discharge disposition, and inflation-adjusted charges of childhood and adolescent TSCI in the U.S. using emergency department (ED) data from the Nationwide Emergency Department Sample (2007-2010). Patients ages 17 years and younger with a diagnosis of acute TSCI were identified using the International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 806.* and 952.* (N = 6132). The cumulative incidence of childhood and adolescent TSCI averaged 17.5 per million population per year. The median age at presentation was 15 years (interquartile range [IQR] = 12-16) and the majority of patients were male (72.5%). The overall median new injury severity score (NISS) was 16 (IQR = 9-27), remaining unchanged during the study duration (p=0.703). Children 5 years and younger were more likely to be injured from a road traffic accident (RTA; 50.9%), sustain C1-C4 injuries (47.4%), have more severe injury (median NISS = 22; IQR = 13-29), and concurrent brain injury (24%) compared to older children and adolescents, p<0.001. Firearms were implicated in 8.3% of injuries, of which 94.7% were among adolescents ages 13-17 years. Of the 35 TSCI-related ED deaths, 40% occurred among children ages 5 years and younger. 62.4% of patients required inpatient admission. Despite stable cumulative incidence and overall injury severity, ED treatment charge per visit increased on average $1394 from $3495 in 2007 to $4889 in 2010 (p=0.008). RTA-related TSCI disproportionately affects young children, while firearm-related TSCI is most common among adolescents. These findings inform TSCI prevention strategies. Prevention may be key in mitigating rising healthcare cost.
authors.affiliation: 1 Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Shalini
authors.initials: S
authors.lastname: Selvarajah
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Daniel
authors.initials: D
authors.lastname: Becker
authors.forename: Cristina L
authors.initials: CL
authors.lastname: Sadowsky
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Edward R
authors.initials: ER
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D013119:Spinal Cord Injuries / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: Nationwide Emergency Department Sample; adolescents; burden; children; epidemiology; traumatic spinal cord injury