Incidence and Characteristics of Cervical Spine Injuries in Young Children Presenting to Community Emergency Departments
Zaid S. Alazawi, Mahim Naveed, Edward J. Durant, Tony ZitekObjectives:
In 2024, the Pediatric Emergency Care Applied Research Network published a cervical spine injury (CSI) prediction rule derived from level 1 pediatric trauma centers. The epidemiology and clinical characteristics of CSI among young children presenting to community emergency departments (EDs) are less well described. We therefore sought to describe the baseline risk and clinical characteristics of CSI among young children presenting to community EDs and to provide context for the application of existing imaging recommendations in this setting.
Methods:
We conducted a retrospective chart review of ED encounters among children aged 0 to 8 years within Kaiser Permanente Northern California between January 1, 2010 and December 31, 2024. Diagnosis and procedure codes were used to identify potential CSI cases, which were confirmed by manual chart review. Clinical characteristics and outcomes were abstracted, and the presence of PECARN imaging criteria was assessed.
Results:
A total of 723,459 unique children aged 0 to 8 years accounted for 1,826,598 ED visits. Nine patients were diagnosed with traumatic CSI (1 per 202,955 visits). None required surgery or had neurological deficits at discharge. PECARN imaging criteria were present in all cases, with CT suggested in 1 patient (11.1%) and radiography in 8 (88.9%). In 2 cases, initial radiographs were normal, and injuries were subsequently identified on advanced imaging.
Conclusions:
CSI in young children presenting to community EDs was exceedingly rare and associated with favorable outcomes. The very low prevalence highlights the importance of balancing diagnostic sensitivity with minimization of radiation exposure in neurologically intact children.