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Cervical Spine Injuries in Children Associated With Sports and Recreational Activities

Babcock, Lynn, MD, MS*; Olsen, Cody S., MS; Jaffe, David M., MD; Leonard, Julie C., MD, MPH§ on behalf of the Cervical Spine Study Group for the Pediatric Emergency Care Applied Research Network (PECARN)

doi: 10.1097/PEC.0000000000000819
Original Articles

Objective The aim of this study was to ascertain potential factors associated with cervical spine injuries in children injured during sports and recreational activities.

Methods This is a secondary analysis of a multicenter retrospective case-control study involving children younger than 16 years who presented to emergency departments after blunt trauma and underwent cervical spine radiography. Cases had cervical spine injury from sports or recreational activities (n = 179). Comparison groups sustained (1) cervical spine injury from other mechanisms (n = 361) or (2) other injuries from sports and recreational activities but were free of cervical spine injury (n = 180).

Results For children with sport and recreational activity–related cervical spine injuries, common injury patterns were subaxial (49%) and fractures (56%). These children were at increased odds of spinal cord injury without radiographic abnormalities compared with children with cervical spine injuries from other mechanisms (25% vs 6%). Children with sport and recreational activity–related trauma had increased odds of cervical spine injury if they had focal neurologic findings (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.5–9.4), had complaints of neck pain (OR, 3.1; 95% CI, 1.9–5.0), were injured diving (OR, 43.5; 95% CI, 5.9–321.3), or sustained axial loading impacts (OR, 2.2; 95% CI, 1.3–3.5). Football (22%), diving (20%), and bicycle crashes (11%) were the leading activities associated with cervical spine injury.

Conclusions In children injured during sports and recreational activities, focal neurologic findings, neck pain, axial loading impacts, and the possibility of spinal cord injury without radiographic abnormality should guide the diagnostic evaluation for potential cervical spine injuries. Certain activities have a considerable frequency of cervical spine injury, which may benefit from activity-specific preventive measures.

From the *Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH;

Department of Pediatrics, PECARN Data Coordinating Center, University of Utah School of Medicine, Salt Lake City, UT;

Division of Emergency Medicine, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA; and

§Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.

Disclosure: The authors declare no conflict of interest.

Reprints: Lynn Babcock, MD, MS, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (e-mail: lynn.babcock@cchmc.org).

Supported by the Health Resources and Services Administration/Maternal and Child Health Bureau (HRSA/MCHB) and Emergency Medical Services of Children (EMSC) Program (H34 MCO4372). The Pediatric Emergency Care Applied Research Network is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the EMSC program of the MCHB, HRSA, US Department of Health and Human Services.

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