Kemp, Alison Mary ![]() |
Abstract
Aim: Systematic review of: “What are the clinical and radiological characteristics of inflicted spinal injury?” Methods: Literature search of 20 electronic databases, websites, references and bibliographies (1950- 2009) using selected keywords. Critical appraisal: by two trained reviewers, (a third review, if discrepant). Inclusion criteria: primary studies of inflicted spinal injury in children <18 years, alive at presentation, with a high surety of diagnosis of abuse and sufficient detail to analyse. Results: 19 studies of 25 children were included. Twelve children, (median age 5 months) had cervical injury. In seven cases the clinical signs of spinal injury were masked by respiratory symptoms and impaired levels of consciousness, six of these children had co-existent inflicted head trauma. Twelve children with thoraco-lumbar injury (median age 13.5 months), 10/12 had lesions at T11-L2, 9/12 were fracture dislocations. All children had focal signs: 10/12 had lumbar kyphosis or thoraco-lumbar swelling, two had focal neurology. One child had cervical, thoracic and sacral injuries. Conclusions: Spinal injury is a potentially devastating inflicted injury in infants and young children. The published evidence-base is limited. However this case series leads us to recommend that any clinical or radiological indication of spinal injury warrant a MRI. In children undergoing brain MRI for abusive head trauma, consideration should be given to including a MRI of the spine. All skeletal surveys in children with suspected abuse should include lateral views of the cervical and thoraco-lumbar spine. Further prospective comparative studies would define the discriminating features of inflicted spinal injuries.
Item Type: | Article |
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Date Type: | Publication |
Status: | Published |
Schools: | Medicine Academic & Student Support Service |
Subjects: | R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services |
Publisher: | BMJ Publishing Group |
ISSN: | 0003-9888 |
Last Modified: | 06 Apr 2024 17:13 |
URI: | https://orca.cardiff.ac.uk/id/eprint/27583 |
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