Pediatric Spinal Injuries in Abuse Cases: A Retrospective Study of Trends from 2012 to 2019

Introduction: Spinal injuries associated with abuse, while rare, can have devastating implications in the pediatric population. This study aimed to analyze trends in pediatric spinal injuries associated with abuse, focusing on the anatomic location of injury, patient demographics, length of stay, and total hospital charges, while comparing outcomes with patients who had spinal injuries but no documented abuse.

Methods: Using data from the Kids' Inpatient Database (KID) for 2012, 2016, and 2019, we identified pediatric patients ( < 18 years) with vertebral fractures or spinal cord injuries (SCI). Abuse cases were identified using ICD codes for non-accidental trauma. Multivariate linear regressions were conducted, adjusting for age, sex, and race. Outcomes included the length of stay, hospital costs, and injury location (thoracic, lumbar, cervical).

Results: A total of 24,000 pediatric spinal injury cases were identified across the three time points, of which 134 (0.56%) had a documented diagnosis of abuse. Physical abuse accounted for 78.2% of the abuse cases. Compared to non-abused patients, abused children were significantly more likely to be under 2 years of age (OR=145.8, 95% CI, 92.4-230.1, p< 0.001), female (OR=1.73, 95% CI, 1.24-2.41, p< 0.01), and of non-white ethnicity (Black: OR=4.03, 95% CI, 2.52-6.45, p< 0.001; Hispanic: OR=3.06, 95% CI, 1.81-5.16, p< 0.001). Abuse-related spinal injuries predominantly affected the thoracic region (OR=2.64, 95% CI, 1.84-3.78, p< 0.001) and were associated with longer hospital stays (mean length of stay increased by 68%) and 55% higher total hospital charges (p < 0.001). Abused children also exhibited a higher likelihood of lumbar fractures compared to non-abused patients (OR=1.83, 95% CI, 1.11-2.78, p< 0.05).

Conclusion : Children with spinal injuries associated with abuse are often younger and experience more severe injuries, particularly in the thoracic and lumbar regions, resulting in longer hospitalizations and increased healthcare costs. Clinicians should maintain a heightened awareness of the potential for abuse in pediatric spinal injury cases, especially in children under 2 years of age. These findings underscore the need for prompt identification and intervention in suspected abuse cases to prevent further harm.