الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Despite the common occurrence of traumatic brain injury (TBI) in pediatric patients, little is known about the co-occurrence of cervical spine injuries (CSIs) in this age group. The anatomy of developing spine in young children may predispose to certain types of CSIs; yet reliable clearance of the cervical spine from physical examination alone can be particularly difficult in young and preverbal children. The aim of the work: The purpose of this study was to review the experience of a level 1 trauma center (Mansoura University Emergency Hospital) to determine incidence, risk factors (including modes of trauma and associated injuries), characteristics (including levels and types of injuries), management options and outcome of cervical spine injuries that concomitant with head trauma in pediatric population. Patients: A prospective study was conducted that included 300 pediatric patients with head trauma (less than 18 years). The patients were divided into 3 age groups: group 1 (less than 3 years), group 2 (3 - 8 years) and group 3 (8 - 18 years). Patients with CSI were identified and compared with non-injured patients. Methods: All patients underwent x-rays of cervical spine, then the diagnosis was confirmed by CT scan in one session with CT brain. Results: Incidence of CSI was about 2%; half was in the upper cervical vertebrae and the other half in the lower cervical vertebrae. MVC and FFH were the most common mode of trauma of CSI. Brain injuries, especially the skull base fracture, was the most common concomitant injury in 66.7 % of CSI. Conclusion: Diagnosis of pediatric CSI is difficult due to anatomical and biomechanical differences compared to adults. The level of cervical injuries varies with the age of the patient as children (< 8 years) tend to develop upper CSI, while older children usually develop lower CSI. Brain injuries are the most common concomitant injuries of pediatric CSI. Upper cervical injuries are closely related to the presence of the fracture base of the skull. Recommendations: Adequate training programs for emergency physicians and radiologists to be familiar with the differences between pediatric and adult cervical spines. Whenever a child with a suspected CSI is encountered, immediate immobilization in neutral position needs to be performed, until the injury is ruled out. Future larger studies on pediatric patients with head trauma should be carried out to define the accurate incidence, risk factors, types and patterns of CSIs. It is necessary to improve the efficacy of radiographic techniques to further decrease the number of radiographs performed with hazardous radiation exposure.