Paediatric cervical spinal cord injuries in motor vehicle crashes: a national study of injury patterns and restraint use.

BACKGROUND

Paediatric cervical spinal cord injuries (cSCIs) from motor vehicle crashes (MVCs) are rare but often devastating. This study aimed to characterise injury patterns, restraint use and inpatient outcomes among paediatric passengers with cSCI.

METHODS

A retrospective cohort analysis was conducted using the American College of Surgeons Trauma Quality Programme database from 2019 to 2021. Paediatric patients (<18 years) with cSCIs sustained as passengers in MVCs were identified using International Classification of Diseases, Tenth Revision diagnosis and external cause codes. Data included protective device use, demographics, injury mechanisms, SCI severity and hospital outcomes. χ2 and Monte Carlo simulations were used for categorical comparisons, with significance set at p<0.05.

RESULTS

A total of 233 paediatric MVC passengers with cSCI were included. The cohort was 21.0% aged 0-3 years, 42.1% aged 4-12 years and 36.9% aged 13-17 years, with 51.9% males and 53.2% White. Restraint use was documented in 58.4% of patients, and 46.4% experienced airbag deployment. Complete cSCI occurred in 34.3% of patients, and 60.3% of these involved C3 or above. Dislocations were more common in younger children, while fractures and cervical spine surgery occurred more frequently in older patients (p<0.001). In-hospital mortality was 20.6% overall but significantly lower in the oldest group (p=0.002). Nearly half (48.9%) were discharged to institutional care.

CONCLUSIONS

cSCI patterns varied significantly by age group. Restraints were used in only 58.4% of cases, highlighting a critical gap in safety implementation. Given potential confounders, associations with injury severity should be interpreted cautiously.