Comparison of cervical versus thoracic spinal cord injury outcomes in pediatric trauma patients

Abstract

Purpose
To explore differences based on level of pediatric spinal cord injury (SCI), we compared cervical and thoracic SCI in pediatric trauma patients (PTPs), hypothesizing higher mortality and length of stay (LOS) for cervical SCI.

Methods
The 2017–2021 Trauma Quality Improvement Program was queried for all PTPs ≤ 17 years-old with cervical or thoracic SCI. Bivariate analyses compared the two groups. The primary outcome was mortality and secondary outcomes included hospital LOS and injury severity scores (ISS). Logistic regression models were used to determine independent risk factors for death and prolonged ventilation.

Results
Of 5280 PTPs, 2538 (65.9%) had cervical SCI and 1316 (34.1%) had thoracic SCI. Motor vehicle collisions were the most common cause of both cervical and thoracic SCI (37.8 and 41.9%). PTPs with thoracic SCI had higher rates of positive drug screen as compared to cervical SCI (39.2 vs 29.8%, p = 0.001). PTPs with thoracic SCI had higher median ISS (25 vs 16, p < 0.001), while cervical SCI had higher mortality (13 vs 6.1%, p < 0.001) but decreased hospital LOS (median 9 vs 5 days, p < 0.001. Cervical SCI were associated with a nearly fourfold increase in the risk of death (95% CI 2.750–5.799, p < 0.001) and a 1.6-fold increase in the risk of prolonged ventilator requirement (95% CI 1.228–2.068, p < 0.001).

Conclusions
PTPs with cervical SCI have higher mortality while those with thoracic SCI have higher ISS and hospital LOS. Cervical SCI were associated with a fourfold higher risk of death. MVC was the most common cause of injury, and both groups had high rates of positive drug screens. Understanding differing outcomes may assist providers with prognostication and injury prevention.

Full text

Vol.:(0123456789)
Pediatric Surgery International (2025) 41:86
https://doi.org/10.1007/s00383-024-05933-4
ORIGINAL ARTICLE
Comparison ofcervical versusthoracic spinal cord injury outcomes
inpediatric trauma patients
AliceM.Martino1· AregGrigorian1,2· CatherineM.Kuza3· SigridBurruss1,2· LourdesSwentek1,2· YigitGuner4·
LauraF.Goodman4· JeryNahmias1,2
Accepted: 9 December 2024
© The Author(s) 2025
Abstract
Purpose To explore differences based on level of pediatric spinal cord injury (SCI), we compared cervical and thoracic SCI
in pediatric trauma patients (PTPs), hypothesizing higher mortality and length of stay (LOS) for cervical SCI.
Methods The 2017–2021 Trauma Quality Improvement Program was queried for all PTPs ≤ 17years-old with cervical or
thoracic SCI. Bivariate analyses compared the two groups. The primary outcome was mortality and secondary outcomes
included hospital LOS and injury severity scores (ISS). Logistic regression models were used to determine independent risk
factors for death and prolonged ventilation.
Results Of 5280 PTPs, 2538 (65.9%) had cervical SCI and 1316 (34.1%) had thoracic SCI. Motor vehicle collisions were
the most common cause of both cervical and thoracic SCI (37.8 and 41.9%). PTPs with thoracic SCI had higher rates of
positive drug screen as compared to cervical SCI (39.2 vs 29.8%, p = 0.001). PTPs with thoracic SCI had higher median ISS
(25 vs 16, p < 0.001), while cervical SCI had higher mortality (13 vs 6.1%, p < 0.001) but decreased hospital LOS (median 9
vs 5days, p < 0.001. Cervical SCI were associated with a nearly fourfold increase in the risk of death (95% CI 2.750–5.799,
p < 0.001) and a 1.6-fold increase in the risk of prolonged ventilator requirement (95% CI 1.228–2.068, p < 0.001).
Conclusions PTPs with cervical SCI have higher mortality while those with thoracic SCI have higher ISS and hospital LOS.
Cervical SCI were associated with a fourfold higher risk of death. MVC was the most common cause of injury, and both
groups had high rates of positive drug screens. Understanding differing outcomes may assist providers with prognostication
and injury prevention.
Keywords Pediatric trauma· Spinal cord injury· Mortality· Substance use
* Jeffry Nahmias
jnahmias@hs.uci.edu
Alice M. Martino
alicemm1@hs.uci.edu
Areg Grigorian
agrigori@hs.uci.edu
Catherine M. Kuza
catherine.kuza@gmail.com
Sigrid Burruss
burrusss@hs.uci.edu
Lourdes Swentek
lyrobles@hs.uci.edu
Yigit Guner
yguner@choc.org
Laura F. Goodman
lgoodman@choc.org
1 Department ofSurgery, University ofCalifornia Irvine
Medical Center, 333 The City Blvd West, Suite 1600,
Orange, CA92868-3298, USA
2 Division ofTrauma, Burns, Critical Care andAcute Care
Surgery, University ofCalifornia Irvine Medical Center,
Orange, CA, USA
3 Department ofAnesthesiology andCritical Care Medicine,
Harbor-UCLA Medical Center, Torrance, CA, USA
4 Department ofPediatric Surgery, Children’s Hospital
ofOrange County, Orange, CA, USA
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Pediatric Surgery International (2025) 41:86 86 Page 2 of 8
Introduction
Spinal cord injury (SCI) in the pediatric population is
uncommon, affecting only 1.5% of injured children [1,
2]. Due to embryologic and anatomical differences, chil-
dren’s spines are more vulnerable to injury than those of
adults. In children eight years and younger, the spine is
hypermobile and due to ligamentous laxity, shallow facet
joints, and incomplete ossification, the risk of ligamentous
injury is higher than for adults [3, 4]. Young children are
also at particular risk for SCI because their spines are able
to stretch more than their spinal cord—one study found
that while the spine of an infant can stretch up to five
centimeters, the spinal cord ruptures after only 5–6mm of
traction [5]. Additionally, the proportionally larger heads
of children shifts the fulcrum of injury upwards, leading
to more frequent high cervical spine injuries compared to
adults [3, 4].
Based on previous small studies, cervical SCI is more
common than thoracic SCI, especially in children eight
years and younger [2, 6]. The thoracic spine is the least
commonly injured region in this age group [6]. However,
data regarding injury patterns in pediatric SCI remain
limited, as studies tend to broadly focus on spinal injury
or are limited to a specific portion of the spinal column
(e.g., cervical). One single center study of pediatric spine
injuries found that location of injury correlated with dis-
tinct injury patterns: upper cervical spine injuries were
associated with orthopedic injuries, lower cervical spine
was associated with maxillofacial injury, and the lower
thoracic spine was associated with gastrointestinal injury
[7]. Furthermore, while data on adult spine injuries exist,
demonstrating that higher spine injuries correlate with
higher mortality and longer hospital stays, similar detailed
data for the pediatric population are lacking [8, 9]. Given
the paucity of data directly comparing cervical and tho-
racic SCI in the pediatric population and the potential for
differences in outcomes, we sought to utilize a national
database to describe cervical and thoracic SCI in children
and compare outcomes. We hypothesized that cervical SCI
would be associated with higher mortality and hospital
length of stay (LOS), compared to thoracic SCI.
Methods
This study involved a retrospective analysis of the Ameri-
can College of Surgeons Trauma Quality Improvement
Program (TQIP) database. We queried the database for
trauma patients ≤17years of age admitted to participat-
ing trauma centers from 2017–2021 with a cervical or
thoracic SCI, as identified by International Classifications
of Diseases (ICD) version-10 diagnosis codes. Complete
and incomplete lesions were identified by ICD-10 codes
(see Supplemental Table1). Patients with both a cervi-
cal and thoracic SCI, as well as those with lumbar SCIs,
were excluded from analysis. This allowed us to compare
patients with only cervical SCI to patients with only tho-
racic SCI. This study was deemed exempt by our Institu-
tional Review Board and a waiver of consent granted, as
the study utilized de-identified patient data from the TQIP
database.
The primary outcome was mortality. Secondary outcomes
included hospital LOS, intensive care unit (ICU) LOS, ven-
tilator days, and major complications (stroke, cardiac arrest,
unplanned intubation, pulmonary embolism (PE), deep vein
thrombosis (DVT), catheter-associated urinary tract infec-
tion (CAUTI), central line associated blood stream infec-
tion (CLABSI), and surgical site infections). To account
for survivor bias, hospital LOS was only analyzed among
survivors. Additional data variables collected were age, sex,
and comorbidities including attention deficit/hyperactivity
disorder (ADHD), mental disorders (schizophrenia, bipolar
disorder, major depressive disorder, social anxiety disorder,
posttraumatic stress disorder, antisocial personality disor-
der), diabetes, pre-trauma steroid use, and drug and alcohol
screen results. The injury profile of patients was character-
ized by mechanism of injury such as motor vehicle collisions
(MVCs), falls, auto versus pedestrian, bicycle and motorcy-
cle collisions, gunshot wounds and stab wounds, as well as
concomitant injuries by organ system and injury severity
score (ISS). Vital signs on arrival were also collected. For
the purposes of this study, hypotension was defined as sys-
tolic blood pressure <90mmHg, tachypnea was defined as a
respiratory rate >22 breaths per minute, and tachycardia was
defined as a heart rate of >120 beats per minute.
Statistical analysis
Continuous variables were reported as medians with inter-
quartile ranges and were analyzed using the Mann–Whitney
U test. Categorical variables were reported as frequencies
and analyzed using chi square test. A p value <0.05 was
set as the threshold for statistical significance. A multi-
variable logistic regression model was utilized to identify
independent risk factors for death and prolonged intubation.
Prolonged intubation was defined as 4days or longer. This
model included variables that were chosen by co-author con-
sensus after review of the literature [10–12] and that were
deemed significant in the univariate analysis with a p-value
of <0.20. The model controlled for age, injury severity,
hypotension, tachycardia, smoking history, and penetrating
trauma. All p-values were two sided, with a statistical sig-
nificance level of <0.05. All analyses were performed with
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Pediatric Surgery International (2025) 41:86 Page 3 of 8 86
IBM SPSS Statistics for Windows (Version 29, IBM Corp.,
Armonk, NY).
Results
Demographics andinjury profiles ofchildren
withcervical versusthoracic SCI
Of 3,854 pediatric trauma patients, 2,538 (65.9%) had cer-
vical SCI and 1,316 (34.1%) had thoracic SCI. Compared
to children with thoracic SCI, those with cervical SCI
were slightly younger (median 14 vs 15 years, p < 0.001).
Both groups were predominantly male (68.8 vs 68.1%,
p = 0.66). Children with cervical SCI less commonly had
mental disorders (3.7 vs 6.0%, p = 0.001), smoking (2.3 vs
4.6%, p < 0.001), and positive drug screens (29.8 vs 39.2%,
p = 0.001, Table1). 341 cervical SCI and 386 thoracic SCI
were identified as complete, and 565 cervical SCI and 297
thoracic SCI were identified as incomplete (Supplemental
Table2).
Cervical SCI was more often caused by falls (26.1 vs
23.8%, p < 0.001) and auto vs pedestrian (4.7 vs 2.8%,
p = 0.005) and less commonly resulted from MVC (37.8 vs
41.9%, p = 0.014), gunshot wounds (6.6 vs 26.7%, p < 0.001),
and motorcycle collisions (1.4 vs 2.7%, p = 0.004) com-
pared to thoracic SCI. Patients with cervical SCI were less
often hypotensive (11.1 vs 13.8%, p = 0.018), tachypneic
(31.2 vs 39.3%, p < 0.001), and tachycardic (15.1 vs 21.8%,
p < 0.001) on arrival compared to thoracic SCI. Patients with
cervical SCI had a lower median ISS than those with tho-
racic SCI (16 vs 25, p < 0.001) (Table2).
Cervical SCI patients had higher rates of brain injury
compared to thoracic SCI (27.7 vs 16.3%, p < 0.001), but
lower rates of most other injuries including lung (24.4 vs
54.1%, p < 0.001), ribs (8.4 vs 32.1%, p < 0.001), and many
abdominal organs (Table2).
Complications andoutcomes ofchildren
withcervical versusthoracic SCI
Compared to thoracic SCI patients, cervical SCI patients had
higher mortality (13.0 vs 6.1%, p < 0.001). However, cer vi-
cal SCI patients had a shorter median hospital LOS (5 vs 9
days, p < 0.001). In terms of other outcomes, rates of DVT
(1.1 vs 2.0%, p = 0.040) and PE (0.1 vs 0.2%, p = 0.021)
were lower in patients with cervical SCI compared to those
with thoracic SCI. Patients with cervical SCI also had lower
rates of unplanned return to the operating room (1.1 vs 1.9%,
p = 0.033) but increased ventilator days (6 vs 4, p < 0.001)
(Table3). After excluding patients who died during their
hospitalization, cervical SCI continued to have lower rates
of DVT (2.0 vs 1.2%, p = 0.049) and unplanned return to
operating room (2.0 vs 1.2%, p = 0.048), while rates of
PE were no longer significantly different. Ventilator days
remained significantly higher in those with cervical SCI (9
vs 4, p < 0.001), and ICU LOS was significantly higher in
those with cervical SCI (6 vs 5 days, p = 0.009) (Supple-
mental Table3).
Logistic regression models forrisk ofdeath
andprolonged intubation
When controlling for ISS, age, hypotension, tachycardia,
smoking history, and penetrating mechanism, cervical
SCI was associated with a nearly fourfold increased risk
of death (95% CI 2.750–5.799, p < 0.001). ISS (OR 1.057,
95% CI 1.049–1.064, p < 0.001), penetrating mechanism
Table 1 Demographics of
pediatric trauma patients with
cervical versus thoracic spinal
cord injury (SCI)
ADHD attention deficit hyperactivity disorder
* denotes statistical significance, p value <0.05
Characteristic Cervical SCI
n = 2538 (65.9%)
Thoracic SCI
n = 1316 (34.1%)
p-value
Age (years), median (IQR) 14 (6) 15 (5) <0.001*
Male, n (%) 1741 (68.8%) 895 (68.1%) 0.669
Comorbidities, n (%)
ADHD 158 (6.3%) 76 (5.9%) 0.608
Mental disorder 94 (3.7%) 78 (6.0%) 0.001*
Smoking 58 (2.3%) 59 (4.6%) <0.001*
Congenital anomalies 66 (2.6%) 21 (1.6%) 0.050
Diabetes 9 (0.4%) 8 (0.6%) 0.255
Functionally dependent 12 (0.5%) 1 (0.1%) 0.045*
Steroid use 2 (0.1%) 2 (0.2%) 0.499
Alcohol screen positive 74 (7.8%) 60 (9.9%) 0.143
Drug screen positive 203 (29.8%) 176 (39.2%) 0.001*
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Pediatric Surgery International (2025) 41:86 86 Page 4 of 8
(OR 3.117, 95% CI 2.104–4.618, p < 0.001), and hypoten-
sion (OR 9.660, 95% CI 7.101–13.141, p < 0.001) were also
independent risk factors for death (Table4A). Cervical SCI
was also associated with a 1.6-fold higher risk for prolonged
intubation (95% CI 1.228–2.068, p < 0.001) (Table4B).
Discussion
SCI in pediatric patients, although rare, results in significant
lifelong disabilities and medical costs estimated at 4.5mil-
lion dollars over a lifetime [6]. This retrospective national
database review demonstrated that falls more commonly
resulted in cervical SCI than thoracic SCI, while MVCs,
gunshot wounds, auto vs pedestrian, and motorcycle colli-
sions more often led to thoracic SCI. Furthermore, substance
and alcohol use were more common in children with tho-
racic SCI. Finally, this study demonstrated higher mortality
and ventilator days for children with cervical SCI, however
children with thoracic SCI had higher overall injury burden
(e.g., ISS) and hospital LOS.
Substance use disorder has a known correlation with
traumatic injury in both adults [13–17] and children [18,
19]. The current analysis found that over 30% of children
Table 2 Injury profile of
pediatric trauma patients with
cervical versus thoracic spinal
cord injury (SCI)
SBP systolic blood pressure
RR respiratory rate
ISS injury severity score
IQR interquartile range
* denotes statistical significance, p value <0.05
Characteristic Cervical SCI
n = 2538 (65.9%)
Thoracic SCI
n = 1316 (34.1%)
p-value
Mechanism, n (%)
Motor vehicle collision 959 (37.8%) 551 (41.9%) 0.014*
Fall 662 (26.1%) 207 (23.8%) <0.001*
Gunshot wound 167 (6.6%) 352 (26.7%) <0.001*
Auto vs pedestrian 119 (4.7%) 37 (2.8%) 0.005
Bicycle collision 68 (2.7%) 35 (2.7%) 0.971
Motorcycle collision 36 (1.4%) 36 (2.7%) 0.004*
Stab wound 7 (0.3%) 5 (0.4%) 0.582
Initial vital signs, n (%)
Hypotensive (SBP < 90mmHg) 273 (11.1%) 177 (13.8%) 0.018*
Tachypneic (RR > 22) 753 (31.2%) 497 (39.3%) <0.001*
Tachycardic (heart rate > 120) 375 (15.1%) 283 (21.8%) <0.001*
ISS, median (IQR) 16 (20) 25 (16) <0.001*
Concomitant Injuries, n (%)
Brain 702 (27.7%) 215 (16.3%) <0.001*
Cardiac 28 (1.1%) 27 (2.1%) 0.019*
Lung 614 (24.4%) 712 (54.1%) <0.001*
Rib 212 (8.4%) 422 (32.1%) <0.001*
Diaphragm 17 (0.7%) 44 (3.3%) <0.001*
Liver 152 (6.0%) 136 (10.3%) <0.001*
Spleen 118 (4.6%) 114 (8.7%) <0.001*
Kidney 70 (2.8%) 92 (7.0%) <0.001*
Pancreas 21 (0.8%) 19 (1.4%) 0.073
Esophagus 2 (0.1%) 13 (1.0%) <0.001*
Stomach 5 (0.1%) 20 (1.5%) <0.001*
Small intestine 63 (2.5%) 39 (3.0%) 0.377
Colon 42 (1.7%) 39 (3.0%) 0.007*
Rectum 5 (0.2%) 3 (0.2%) 0.841
Bladder 8 (0.3%) 7 (0.5%) 0.306
Upper extremity fracture 161 (6.3%) 124 (9.4%) <0.001*
Lower extremity fracture 191 (7.5%) 106 (8.1%) 0.559
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Pediatric Surgery International (2025) 41:86 Page 5 of 8 86
with SCI had a positive drug screen and nearly 10% tested
positive for alcohol. This is corroborated by several stud-
ies that have demonstrated substance use disorder as a risk
factor for SCI in adults [20–22], as well as one study of
both adult and pediatric patients with brain and spine inju-
ries resulting from ATV crashes, which found nearly 50%
of cases involved alcohol intoxication [23]. Our study also
Table 3 Complications and
outcomes of pediatric trauma
patients with cervical versus
thoracic spinal cord injury (SCI)
CAUTI catheter associated urinary tract infection
CLABSI central line associated bloodstream infection
LOS length of stay
ICU intensive care unit
IQR interquartile range
* denotes statistical significance, p value <0.05
Characteristic Cervical SCI
n = 2538 (65.9%)
Thoracic SCI
n = 1316 (34.1%)
p-value
Complications, n (%)
Delirium 10 (1.8%) 8 (2.8%) 0.369
Stroke 7 (0.3%) 7 (0.5%) 0.211
Cardiac arrest 82 (3.2%) 29 (2.2%) 0.070
Unplanned intubation 55 (2.2%) 31 (2.4%) 0.711
Ventilator-associated pneumonia 59 (2.3%) 30 (2.3%) 0.932
Respiratory 23 (0.9%) 16 (1.2%) 0.364
Pulmonary embolism 3 (0.1%) 6 (0.2%) 0.040*
Kidney 10 (0.4%) 8 (0.6%) 0.357
Deep vein thrombosis 27 (1.1%) 26 (2.0%) 0.021*
CAUTI 24 (0.9%) 17 (1.3%) 0.322
Sepsis 11 (0.4%) 10 (0.8%) 0.192
Superficial surgical site infection 3 (0.1%) 3 (0.2%) 0.413
Deep surgical site infection 4 (0.2%) 4 (0.3%) 0.345
CLABSI 5 (0.2%) 2 (0.2%) 0.755
Unplanned return to operating room 25 (1.1%) 24 (1.9%) 0.033*
Any complication 328 (12.9%) 196 (14.9%) 0.091
Mortality in hospital, n (%) 329 (13.0%) 80 (6.1%) <0.001*
Hospital LOS, median (IQR) 5 (12) 9 (13) <0.001*
ICU LOS, median (IQR) 5 (10) 5 (7) 0.101
Ventilator Days, median (IQR) 6 (14) 4 (9) <0.001*
Table 4A Logistic regression model predicting death in children with
SCI
Odds Ratio 95% Confidence
interval
p-value
Cervical SCI 3.994 2.750 5.799 <0.001*
ISS 1.057 1.049 1.064 <0.001*
Age (years) 0.919 0.893 0.945 <0.001*
Hypotension (SBP < 90) 9.660 7.101 13.141 <0.001*
Tachycardia (HR > 120) 1.215 0.870 1.696 0.252
Smoking history 0.541 0.176 1.668 0.285
Penetrating trauma 3.117 2.104 4.618 <0.001*
Table 4B Logistic regression model predicting prolonged intubation
in children with SCI
SCI spinal cord injury
ISS injury severity score
SBP systolic blood pressure
HR heart rate
Prolonged intubation defined as 4 or more days
* denotes statistical significance, p value < 0.05
Odds Ratio 95% Confi-
dence interval
p-value
Cervical SCI 1.594 1.228 2.068 <0.001*
ISS 1.014 1.007 1.022 <0.001*
Age (years) 0.988 0.965 1.011 0.306
Hypotension (SBP < 90) 0.617 0.462 0.825 0.001*
Tachycardia (HR > 120) 0.774 0.595 1.008 0.057
Smoking history 0.810 0.412 1.592 0.541
Penetrating trauma 1.027 0.752 1.402 0.867
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Pediatric Surgery International (2025) 41:86 86 Page 6 of 8
demonstrates that thoracic SCI was more likely to be asso-
ciated with both alcohol and substance use than cervical
SCI. Therefore, while pediatric patients are not just small
adults, they similarly have injuries linked to substance and
alcohol use and thus would benefit from increased primary
prevention efforts.
Notably MVC was the most common mechanism for both
cervical and thoracic SCI, followed by falls, which is con-
sistent with prior studies in children [1, 24, 25]. Interest-
ingly, MVCs resulted in more thoracic SCI than cervical
SCI. Existing pediatric literature has predominantly focused
on cervical spine injuries resulting from MVC. One 10year
review of the National Pediatric Trauma Registry found cer-
vical spine injury was rare (1.5% of the study population),
yet cervical SCI was even more rare, comprising only 35%
of those with spinal injury [1]. Importantly, 73% of their
cohort was injured in a MVC, and 61% of these children
were unrestrained at the time of their injury [1]. Similarly,
MVC remains a significant mechanism for thoracolumbar
spine injuries in children as well, comprising 55% of these
injuries, followed by falls (23%) [26]. Given that MVCs
remain the biggest contributors to pediatric SCI of both the
cervical and thoracic spine, it is clear that injury preven-
tion efforts, including correct use of car seats/seat belts, are
still needed. In addition, the automobile industry and federal
agencies responsible for car seat regulations should leverage
this data to try and further optimize these restraint devices
to minimize SCIs in children.
Higher levels of spinal cord injury generally imply
increased level of motor deficit and potential for increased
complications [27]. Thus, not surprisingly, outcomes also
differed between cervical and thoracic SCI. Cervical SCI
were associated with a more than doubled mortality rate
compared to thoracic SCI (13 vs 6%) but had a shorter
median hospital LOS by four days. Our mortality rate for
cervical SCI is comparable to previous work by Brown etal.
[28] (18.5%) for cervical spine injuries at their center. Inter-
estingly, children with cervical SCI in our national analysis
had a lower median ISS [16] compared to those in the Brown
study (ISS = 25) and children in our cohort with thoracic
SCI (ISS = 25). The lower ISS in our cervical SCI cohort
may be due to survivor bias, as children who died shortly
after arrival, likely due to severe injury or high cervical SCI
(which is often fatal [2]) may not have undergone complete
trauma imaging evaluations. Additionally, the higher LOS
and survivorship may help explain why thoracic SCI patients
had increased complications such as sepsis and venous
thromboembolism. However, after excluding patients who
died during their hospital stay, only DVT rates remained
elevated for patients with thoracic SCI. More granular scene
and prospective hospital data are needed to definitively
determine the reason for the differences in mortality and
complications.
Our study has limitations inherent to its nature as a ret-
rospective database analysis, such as missing data, coding
errors, and misclassification. Children with severe injuries
that did not survive to hospitalization were not included in
the TQIP database. In addition, the TQIP database lacks
granular data related to the severity of the SCI including
the American Spinal Injury Association (ASIA) classi-
fication let alone even a distinction for complete versus
incomplete SCI. Also, it lacks pertinent variables known
to effect outcomes in SCI patients such as timing of sur-
gical decompression and degree of neurologic recovery.
Finally, the TQIP database lacks long-term post-discharge
data, such as post hospitalization development of scoliosis,
pressure ulcers, and patient centric outcomes including
quality of life measurements. As SCI is a lifelong con-
dition, more long-term data would be useful to paint a
complete picture of the differences between cervical and
thoracic SCI. Despite these limitations, this study’s large
number of patients and centers adds to the generalizability
of the findings.
Conclusions
In conclusion, this four-year retrospective analysis of pedi-
atric trauma patients in the TQIP database demonstrated dif-
ferences in mechanism of injury and injury pattern between
cervical and thoracic SCI, although MVC was the most com-
mon mechanism for both injuries. Cervical SCI was associ-
ated with higher mortality whereas thoracic SCI patients had
higher ISS, complications, and hospital LOS. These findings
highlight the urgent need for enhanced injury prevention
strategies, especially encouraging safe driving practices
among parents, as MVCs continue to be a major cause of
SCI in children. Future research is needed to improve injury
prevention, especially related to MVCs, and evaluate differ-
ences in long-term outcomes, with the goal of improving the
treatment and quality of life for children with SCI.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s00383- 024- 05933-4.
Author contribution AM: writing-original draft, writing-review and
editing; AG: conceptualization, methodology, formal analysis, data
curation, writing-review and editing, supervision; CK: writing-review
and editing; SB: writing-review and editing; LS: writing-review and
editing; YG: writing-review and editing; LG: writing-review and edit-
ing; JN: conceptualization, writing-review and editing, supervision.
Funding This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Data availability The data that support the findings of this study are not
publicly available but may be obtained by request from the American
College of Surgeons Committee on Trauma.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Pediatric Surgery International (2025) 41:86 Page 7 of 8 86
Declarations
Competing interest The authors declare no competing interests.
Ethics approval This study was conducted retrospectively from de-
identified patient data from the Trauma Quality Improvement Project
database and was therefore deemed exempt by our Institutional Review
Board and a waiver of consent granted.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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