Prognostication of cervical SPINE injury (CSI) in the pediatric trauma patient continues to vary widely across institutions due to lack of evidence-based recommendations and standardization efforts. While MRI is useful for describing soft tissue injury, the relationship of magnitude of injury to sensorimotor outcomes is not well described.Methods: A post-hoc analysis of a prospectively collected database of pediatric patients sustaining trauma from 2010-2019 was screened for patients having been assessed for CSI. Patients were excluded if they did not have cervical MRI in their work-up or were unconscious on arrival. Patient presentation and radiologic reports were reviewed for description of neurologic symptoms and description of CSI. Univariate analysis compared durations of persistent neurological deficits at presentation. Multivariate logistic regression was performed to identify predictors of poor outcome with variables of p < 0.2.
A total of 104 of 242 patients reported subjective neurologic complaint following trauma. Neurologic symptoms resolved prior to arrival 18 patients, persisted < 24 hours in 50 patients and >24 hours in 36 patients, 7 of whom significant sensorimotor deficit (ASIA A, B, or C). Those with >24 hours were more likely to have CT demonstrating injury (63%, p < 0.001), and MRI demonstrating soft tissue injury (53.8%, p < 0.001), including cord edema (44.4%, p < 0.001), prevertebral edema (30.6%, p=0.002), or extra-axial spinal hematoma (27.8%, p < 0.001), among others. Variables predictive of persistent deficit at long-term follow-up included poor pre-operative ASIA score (ASIA A, B, C) (OR 20.2, p = 0.01) and number of soft tissue findings on MRI (OR 1.6, p = 0.0006).
The relative magnitude of soft tissue findings on MRI strongly predicted the risk of permanent neurological deficit independent of pre-operative ASIA score. Careful tabulation of ligamentous injuries may be valuable in the prognostication of cervical trauma in pediatric patients.