Pediatric Spinal Cord Injury: Recognition of Injury and Initial Resuscitation, in Hospital Management, and Coordination of Care

J Pediatr Intensive Care, 2015 · DOI: http://dx.doi.org/10.1055/s-0035-1554986 · Published: January 1, 2015

Simple Explanation

Spinal cord injury (SCI) is uncommon in children, occurring in approximately 1.99 per 100,000 children, and requires specific knowledge regarding spine embryology, mechanisms of injury, and appropriate radiographic imaging. The pediatric population is at a higher risk for spinal cord injury without radiographic abnormality (SCIWORA) than the adult population. Patients who survive the acute phase of injury face long-term rehabilitation and have an increased risk of depression and mortality.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
Cervical injuries make up 80% of all SCIs in children, with 18% of these having atlanto-occipital dislocation, and concomitant head injury may be present in up to three quarters of patients with SCI.
2
The spine in children less than 8 years is hypermobile, placing the occipitoatlantoaxial complex at risk due to the relatively larger head size.
3
SCIWORA is associated with occult instability, and minor trauma can lead to recurrent symptoms; dynamic radiographic follow-up is recommended for all patients with SCIWORA.

Research Summary

Spinal cord injury is uncommon in the pediatric population with a lifelong impact for the patient and family. Prehospital management is focused on maintaining an adequate airway and circulation being careful not to exacerbate a potential spine and head injury. Children with SCI are surviving more. Their length of stay is among the longest in pediatric centers.

Practical Implications

Improved Prehospital Care

Develop immobilization boards that allow positional neutrality for the neck to prevent exacerbation of spine injuries during transport.

Early and Aggressive Management

Focus early care in the ED and ICU on treating shock and respiratory insufficiency to prevent secondary injury.

Long-Term Support Systems

Provide robust help for patients and families to cope with long-term challenges and facilitate the transition to a fulfilling life.

Study Limitations

1
Limited data on definitive pharmacologic management of neurogenic shock.
2
Controversy surrounding the use of steroids in pediatric SCI treatment.
3
Lack of significant evidence to support a protocolized delivery of VTE prophylaxis.

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