Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine evaluation apply?

Although the recommendations to evaluate possible cervical spine injuries in patients with isolated head injuries are identical to those with multiple trauma, to date, no such study has confirmed that risk factors are the same for both injuries. We reviewed the charts of 268 pediatric patients with isolated head injuries admitted to the Intensive Care Unit at Children's Hospital Medical Center (1985-1990) to determine which risk factors were present. In this retrospective study, we divided the patients into two groups: low risk and high risk. The low-risk patients (n = 135) were those capable of verbal communication who did not report cervical discomfort. The high-risk patients (n = 133) either were incapable of verbal communication (preverbal or physically unable due to head injury) or reported neck pain. All patients under 2 years of age were considered preverbal and at high risk. The patients in both groups were indistinguishable by age, sex, mechanism of injury, and type of injury sustained. No patient in the low-risk group suffered cervical spine injury. Cervical spine trauma was present in 10 (7.5%) high-risk patients. Using the method of adjusted odds ratio, we found that high-risk patients had 23 times the likelihood of neck injury when compared with low-risk patients (p = 0.003, 95% confidence limit). Our results indicate that cervical spine X-rays (i.e., anteroposterior, odontoid, lateral views) are indicated only in high-risk pediatric patients with head injuries who either complain of neck pain or cannot voice such complaints because of significant head injury or preverbal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Epiglottitis in infants less than two years of age.

A retrospective review of 41 children less than two years of age was conducted to characterize the clinical presentation of epiglottitis in this young age group. Up to 25% of all cases of epiglottitis occur in children less than two years of age. The clinical presentation of patients in this young age group is variable. Signs and symptoms not routinely described in children over two years of age with epiglottitis but often observed in infants with epiglottitis include the absence of fever, the presence of only low grade fever, a significant history of antecedent URI, and a prominent "croupy" cough. These same features are often noted in children with the viral croup syndrome. A diagnosis of this life-threatening illness may be made promptly through an awareness of the presenting findings observed in infants. Young infants with epiglottitis can be safely managed with short-term nasotracheal intubation.