Patterns of injury, management stratification, and inpatient outcomes in pediatric complete cervical spinal cord injury: insights from a national database

Purpose: Pediatric complete cervical spinal cord injury (cSCI) is rare and associated with severe morbidity and mortality, yet limited data exist to guide management. This study aimed to describe national injury characteristics, management stratification, and inpatient outcomes among children with complete cSCI. Methods: Pediatric patients (< 18 years) with complete cSCI were identified from the American College of Surgeons Trauma Quality Program database (2019–2021). Cases with severe head trauma or pre-hospital deaths were excluded. Patients were grouped into surgical and non-surgical cohorts. Univariate analyses compared demographic, clinical, injury-related, and hospital outcome variables. Analyses were performed in Python 3.7 using Google Colab, with significance set at p < 0.05. Results: Among 125 pediatric patients with complete cSCI (78.4% male, mean age 14.3 years), surgical management (75.2%) was associated with falls (27.7% vs. 3.2%, p = 0.003) and combined fracture-dislocations (44.7% vs. 16.1%, p = 0.008), while non-surgical cases were linked to assaults (41.9% vs. 10.6%, p < 0.001) and injuries at C3 or higher levels (29.0% vs. 10.6%, p = 0.029). Intensive care was universally required, with 73.6% needing ventilation. Most patients (88.8%) were discharged to institutional care, with a total mortality rate of 4.8%. Mortality was significantly lower in the surgical group (1.1% vs. 16.1%, p = 0.004). Conclusion: This analysis identified differing injury patterns, with surgery linked to falls and fracture-dislocations and non-surgical care to upper cervical injuries. Observed differences in mortality should be interpreted cautiously given selection bias and data constraints. Prospective studies are needed.