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Epidemiology of Pediatric SCI

United States

The incidence and prevalence of pediatric SCI in the United States, have received considerable attention from researchers. Piatt and Imperato (2018) looked into the trends in population-based incidences of SCI in children (between ages 0-14) and adolescents (between ages 15-17) by reviewing the Kids’ Inpatient Database (KID) for 1997, 2000, 2003, 2006, 2009 and 2012; the denominator of the proportions for this analysis was taken from U.S. Census data. It was revealed that the annual population-based incidences of hospitalization for a spinal injury and SCI trended downward from 1997 to 2012 for both children and adolescents in the United States. The review also indicated motor vehicle crashes were the most common injury mechanism for both children and adolescents, but penetrating injuries and sports injuries were more commonly linked to SCI (Piatt & Imperato 2018). Data from KID was unitized in several other studies to explore the incidence and prevalence of pediatric SCI in the U.S. One review of trauma cases from 2003 through 2012 queried the KID, putting the focus on CSI cases. The study demonstrated that the incidence of cervical spine injury significantly increased since 2003 (2.39% in 2003 vs 3.12% in 2012, respectively) (Poorman et al. 2019). Likewise, Shin and colleagues (2016) review of the KID from 2000 to 2012 for pediatric CSI (PCSI) admissions found the overall prevalence of traumatic PCSI during those years was 2.07%. In line with the findings from Piatt and Imperato’s (2018) work, Shin et al. (2016) identified transportation accidents as the most common cause of PCSI, accounting for 57.51% of all injury causes.

Another study by Piatt (2015) looked into admissions for spinal fracture without or with SCI) spinal dislocation, and SCIWORA in the KID and the National Trauma Data Bank (NTDB) registry in 2009. The study showed a nationwide pediatric SCI incidence rate of 24 per 1 million, with variations across regions. In addition, it was revealed that Back patients were more likely to experience severe injuries than patients of other races (Piatt 2015). Vitale et al. (2006) analyzed data from 1997 and 2000 from the same databases and suggested that the overall incidence of pediatric SCI in the United States was 1.99 cases per 100,000 children. In addition, significant differences in the annual incidence rate of pediatric SCI were found between patient populations stratified by race and sex. For example, African Americans (1.53 cases/100,000 children) exhibit a significantly higher rate of pediatric SCI than Native Americans (1.00), Hispanics (0.87), and Asians (0.36). Furthermore, males (2.79) were more than twice as likely to experience SCI as females (1.15) (Vitale et al. 2006).

Additional reviews of the NTDB from January 2002 through December 2006 were conducted to identify pediatric patients suffering from blunt trauma. Of pediatric blunt trauma patients, 1.3% sustained CSI. In stratified age groups, the incidence of CSI was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents (Mohseni et al. 2011). Another review of children with CSI entered in the National Pediatric Trauma Registry was carried out during a 10-year period by Patel et al.(2001), in which the researchers found an overall pediatric CSI incidence rate of 1.5%.  

Research has also been conducted to examine the incidence of pediatric SCI in specific states or regions in the United States. In one study, Saunders et al. (2015) identified children and adolescents (0-21 years) who experienced SCI between 1998 and 2012 through the South Carolina CSI Surveillance Registry and found an overall age-adjusted incidence rate of 26.9 per million population, with a trend toward decreasing incidence of pediatric SCI over the years. In northern Manhattan, pediatric deaths and hospital admissions secondary to neurological trauma were accounted for in the Northern Manhattan Injury Surveillance System from 1983 to 1992 and linked to census counts to compute incidence rates. Of neurological injuries, spinal cord and peripheral nerve injuries were relatively rare (5%) compared to head injuries (95%) (Durkin et al. 1998). An earlier study by Kewalramani et al. (1980) looked into acute spinal-cord lesions in children, aged 1 to 15 years. The study investigated injuries that occurred between 1970 and 1971 in 18 Northern California counties and used U.S. Census data as the denominator for incidence proportions. The investigation revealed that, in northern California, the incidence of acute spinal cord lesions in children/adolescents was 18.2 per million population. Males, especially those between the ages of 10-15, were found to be most at risk for such injuries (Kewalramani et al. 1980).

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