Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Background: Motor vehicle crashes (MVC) cause variable injury to the thoracolumbar (TL) region of children secondary to rapid deceleration from seatbelts. This mechanism can also predispose a child to intraabdominal injury (IAI), which necessitates early diagnosis to limit morbidity and mortality. While the maximum extent of TL-spine injury can be appreciated shortly after presentation, the severity of IAI may not be appreciated until days later. It is hypothesized that a measure of TL-injury severity will identify patients at risk of concomitant IAI. Methods: Retrospective chart review identified 72 children with MVC-related TL-spine injuries from 2007-2020. Patients were grouped based on the presence of IAI and TL-spine injury (N=33) compared to isolated TL-spine injury (no IAI, N=39). TL-spine injury severity was classified according to the Thoracolumbar Injury Classification and Severity Scale (TLICS). Results: Demographics were similar in both groups. Children with concomitant IAI had primarily lumbar spine injuries, while injuries without associated IAI were more broadly distributed throughout the thoracolumbar spine. Children without concomitant IAI were more likely to sustain compression fractures (n=31, 79%), while children with IAI had more distraction injuries (n=24, 73%). TL injuries associated with IAI were significantly more severe than isolated TL injures (median TLICS=7 [range: 1-9] vs 1 [range: 1-10], p<0.001). As hypothesized, increasing TLICS is associated with an increased risk of concomitant IAI, such that for every point increase in TLICS, the risk of IAI increases 49% (OR: 1.492, [95% CI 1.254-1.817], AROC 0.795) Conclusions: Given the close association between severe spine injury and IAI, this study illustrates the utility of TLICS score at presentation to establish a high index of suspicion for concomitant IAI. While other clinical signs may be suggestive of the presence of IAI, our study provides clinicians with a new datapoint, a severe spine injury as graded by TLICS (i.e., TLICS >5), in their diagnostic toolbox to optimally manage pediatric patients after MVC.