title: Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern.
abstract: OBJECTIVE
  The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36months with inflicted trauma.
  
  
  METHODS
  An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48h. Variables were compared by t-test and Fisher-exact test.
  
  
  RESULTS
  There were 53 children (median age: five months; range: 1-35months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p=0.02), shaking (p=0.04), lower Glasgow coma score (GCS) (p=0.01), brain infarcts (p=0.01), and hypoxic/ischemic injury (p=0.01) were associated with c-spine injury. One with AOD died. Six had significant disability.
  
  
  CONCLUSIONS
  For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging.
  
  
  METHODS
  Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis.
authors.affiliation: Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA. Electronic address: jbaerg@llu.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: Baerg
authors.affiliation: Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Arul
authors.initials: A
authors.lastname: Thirumoorthi
authors.affiliation: Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Vannix
authors.affiliation: Division of Pediatric Neurosurgery, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Asma
authors.initials: A
authors.lastname: Taha
authors.affiliation: Division of Forensic Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Amy
authors.initials: A
authors.lastname: Young
authors.affiliation: Division of Pediatric Neurosurgery, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zouros
mesh_terms: D002140:California / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality / Q000706:statistics & numerical data; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: Cervical spine injury; Inflicted trauma; Pattern of injury; Shaken infant