Every two in 100,000 children experience spinal cord injury; most occur in MVAs

Study finds 70% of children with SCI from a motor vehicle accident were not wearing a seatbelt.

Issue: July 2006

CHICAGO – The first national evaluation on the epidemiology of pediatric spinal cord injury found that about 2 in every 100,000 children experience spinal cord injury, with motor vehicle accidents accounting for most of the cases.

Nearly 70% of children in motor vehicle accidents (MVAs) who developed spinal cord injury (SCI) failed to wear a seatbelt, according to David Price Roye Jr., MD, of the Children’s Hospital of New York.

In conducting the evaluation, Roye and his colleagues also found that boys are two times more at risk than girls. Further, black children experience the highest SCI incidence, while Asian children experience the lowest.

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Roye and his colleagues found that boys have a two times higher incidence of spinal cord injury than girls.

Source: Roye Jr. DP

“The epidemiology of pediatric spinal cord injury in the United States has been actually unknown for some time,” Roye said at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. “We undertook this [study] in part to identify high-risk populations to try to help us focus attention on groups that are at risk.”

Using population data

Roye and his colleagues used the Kids Inpatient Database (KID) and the National Trauma Database (NTDB) to evaluate the national demographics, etiology, risk factors and high-risk populations for SCI.

They identified 3,118 SCI cases in the KID and another 466 SCI cases in the NTDB. They only included children younger than 19 years and based incidence rates on pediatric discharges from the U.S. Census Bureau populations, Roye said.

Researchers found the incidence of pediatric SCI in the United States is equal to 1.99 cases per 100,000 children, which they estimated to be 1,455 cases annually, Roye said. They also found a mean 2.79 cases per 100,000 boys and 1.15 cases per 100,000 girls. Mean age of injury was 14.6 years old – 14.9 years for boys and 13.8 years for girls.

Frequency of SCI remained steady until children reached 12 years of age. Here, they began a steep rise in SCI frequency, which peaked at 18 years. “This actually is coincident of all forms of orthopedic trauma, so it’s not a big surprise,” Roye said.

Black children demonstrated the highest SCI incidence: 1.53 cases per 100,000 children, which Roye said is “fairly striking and statistically significant.” White children were second highest with 1.33 per 100,000 children and Asian children had the lowest incidence at 0.36 per 100,000 children (P<.01).

Mortality rates

MVAs were overwhelmingly the most likely cause for SCI, accounting for 56%. Accident falls made up 14.2%, firearm accounted for 9.2%, sports 7.7% and 12.9% were other causes, Roye said.

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Trying to identify high-risk populations, Roye and his colleagues determined the SCI incidence by race. They found that black children have the highest incidence, which Roye said is “fairly striking and statistically significant.”

Alcohol and drugs also played a role in SCI. Thirty percent of SCI cases (274 children) tested positive for alcohol or drugs. “Of course, we’re looking at patients under age 19 and so the older of that age group are having motor vehicle accidents related to alcohol or drugs,” Roye said.

Although mortality was difficult to assess in these patients, the researchers determined a 90% survival rate for inpatients. The remaining 10% died in the hospital, Roye said. However, this number does not account for patients who died at the scene or who were dead on arrival to the hospital.

Roye said that the Glasgow Coma Score (GCS) was the best survival predictor for SCI patients. Of those patients with a GCS >4, 99% were alive when discharged from the hospital; whereas, 42.2% of patients with a GCS of 3 died in the hospital.

Some study limitations

Study limitations included the KID’s weighting function, which predicts trends but includes less detail. Other limitations included the low pediatric focus and fewer SCI cases in the NTDB, and the inability to assess mortality for patients who died before hospital admission, Roye said.

The KID, started in 2000, enrolls 2784 hospitals in 22 states and includes 7.3 million weighted discharges. The NTDB, started in 2002 by the American College of Surgeons, includes all 1.1 million trauma patient discharges – not only children – from 405 trauma centers in 45 states.

For more information:
Vitale M, Goss J, Roye D, et al. The epidemiology of pediatric spinal cord injury in the United States. #183. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.