SCI Incidence

Children with SCI

Most paediatric SCIs occur within MVCs, but with a greater initial mortality due to a higher incidence of multiple injuries present at scene. Of these SCI cases, 75% involve significant multi-trauma and 40% are secondary to severe head injuries. Most of these injuries are due to children being improperly secured within a vehicle, if at all. Falls, accidents at home, and sporting accidents are more likely to be survived at this age (Vogel, et al 1997; Martin, et al 2004).

Martin, et al (2004) reviewed the incidence of paediatric spinal trauma cases recorded on the UK Trauma Audit and Research Database between 1989-2000 and calculated that 2.7% of paediatric trauma cases suffered significant spinal column injury without SCI. 0.56% of all child trauma admissions and 16.5% of all spine injured children involved actual SCI. Of the 731 SCI Centre admissions during 2001, there were 7 children aged 0-9 (1% of all admissions) and 72 children aged 10-19 (9.8% of all admissions).

The inherent instability, laxity and range of movement of the paediatric cervical spine, coupled with the disproportionate size of a child’s head compared with the body, means that cervical lesions predominate in very young children (Martin, et al 2004). However, it is not unusual for a child to present with the symptoms of a spinal cord lesion with no evidence of a fracture or other bony injury. This is termed ‘spinal cord injury without radiological abnormality or SCIWORA (Pang & Wilberger 1982).

Within the UK SCI service, children with SCI are not perceived just as little adults, but rather as unique individuals with complex care and developmental needs which may not be best served through admission to a predominantly adult environment. The introduction of enhanced regulations governing the hospitalisation of children has meant that each SCI Centre has had to undertake a complete review of its potential to admit children. Comprehensive assessment of facilities, resources and personnel available within each SCI Centre has led to variation in when a child is referred to the SCI Centre, whether the centre is able to admit children and at what age a child may be admitted if appropriate. Consequently, many SCI Centres are severely restricted in their ability to admit SCI children. Instead, SCI Centre staff will be called upon to provide outreach liaison services to SCI children admitted to local paediatric facilities as appropriate.

As with SCI adults, there should be no delay in referring a SCI child to a SCI Centre. Even if the initial care and rehabilitation of that child is intended to be undertaken outside of the SCI Centre, each child should be expected to survive into adulthood, at which point they will be discharged from local general child services in the expectation that the regional SCI Centre will continue to provide for their ongoing healthcare needs.  If the SCI Centre can be enabled to support and influence the early management and post-discharge monitoring of the SCI child, the more informed and easier their transition into adulthood should be.

  • Martin BW; Dykes E; Lecky FE. (2004). Patterns and risks in spinal trauma. Archives of the Disabled Child. 89: 860-865.
  • Pang D, Wilberger JE (1982) Spinal cord injury without radiographic abnormalities in children. Journal of Neurosurgery 57: 114–129.
  • Vogel L, Mulcahy MJ, Betz R (1997) The child with spinal cord injury. Developmental Medicine and Child Neurology 39: 202–207