Trauma across pediatric ages: a retrospective analysis of age-stratified epidemiology, injury patterns, and outcomes in pediatric cervical spinal cord injury using the National Trauma Data Bank

OBJECTIVE: Pediatric cervical spinal cord injury (cSCI) is a severe form of trauma with age-dependent anatomical and physiological risks that affect treatment strategies and outcomes. Due to the lack of comprehensive national-level data, this study aimed to evaluate age-specific differences in epidemiology, injury patterns, and clinical outcomes in pediatric patients with traumatic cSCI. METHODS: The authors performed a retrospective analysis using the National Trauma Data Bank (2007-2018) to identify pediatric patients (≤ 18 years old) with traumatic cSCI and stratified them into newborns/infants, toddlers, children, and adolescents. The primary outcome was early mortality. Multivariable logistic regression identified predictors of mortality, complications, and discharge outcomes, adjusting for relevant clinical variables. RESULTS: A total of 4696 pediatric patients with cSCI were identified. While adolescents (71.9%) and children (20.5%) accounted for most cases, newborns/infants and toddlers had higher mortality rates (25.6% and 22.1%, respectively; p < 0.001). Motor vehicle traumas predominated in younger children, whereas firearm injuries were more common in adolescents. Younger groups experienced significantly longer intensive care unit stays, extended ventilator use, and higher complication rates. Toddlers (OR 1.86, p = 0.014), critical injury severity (OR 3.60), and Glasgow Coma Scale (GCS) scores of 3-5 (OR 51.51) were associated with significantly higher odds of death. Greater injury severity and lower GCS scores were also associated with a higher risk of complications. Use of protective devices and venous thromboembolism prophylaxis were associated with lower mortality. CONCLUSIONS: Among pediatric patients with cSCI, infants and toddlers predominantly experienced motor vehicle-related and more severe injury, and worse clinical outcomes, which requires aggressive early management and age-appropriate trauma protocols. In contrast, firearm and recreational injuries were more common among adolescents, reinforcing the necessity of targeted prevention and community education. These findings highlight the importance of age-specific strategies in both clinical care and injury prevention for this high-risk population.