{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:56Z","timestamp":1787017016042,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2026,2,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paediatric cervical spinal cord injuries (cSCIs) from motor vehicle crashes (MVCs) are rare but often devastating. This study aimed to characterise injury patterns, restraint use and inpatient outcomes among paediatric passengers with cSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort analysis was conducted using the American College of Surgeons Trauma Quality Programme database from 2019 to 2021. Paediatric patients (&lt;18 years) with cSCIs sustained as passengers in MVCs were identified using International Classification of Diseases, Tenth Revision diagnosis and external cause codes. Data included protective device use, demographics, injury mechanisms, SCI severity and hospital outcomes. \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      and Monte Carlo simulations were used for categorical comparisons, with significance set at p&lt;0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 233 paediatric MVC passengers with cSCI were included. The cohort was 21.0% aged 0\u20133 years, 42.1% aged 4\u201312 years and 36.9% aged 13\u201317 years, with 51.9% males and 53.2% White. Restraint use was documented in 58.4% of patients, and 46.4% experienced airbag deployment. Complete cSCI occurred in 34.3% of patients, and 60.3% of these involved C3 or above. Dislocations were more common in younger children, while fractures and cervical spine surgery occurred more frequently in older patients (p&lt;0.001). In-hospital mortality was 20.6% overall but significantly lower in the oldest group (p=0.002). Nearly half (48.9%) were discharged to institutional care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>cSCI patterns varied significantly by age group. Restraints were used in only 58.4% of cases, highlighting a critical gap in safety implementation. Given potential confounders, associations with injury severity should be interpreted cautiously.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-045888","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:20:22Z","timestamp":1770834022000},"page":"ip-2025-045888","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Paediatric cervical spinal cord injuries in motor vehicle crashes: a national study of injury patterns and restraint use"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8469-0656","authenticated-orcid":false,"given":"Sean","family":"Inzerillo","sequence":"first","affiliation":[{"name":"SUNY Downstate Medical Centre College of Medicine, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Toumbas","sequence":"additional","affiliation":[{"name":"University of Cambridge School of Clinical Medicine, Cambridge, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert","family":"Karabacak","sequence":"additional","affiliation":[{"name":"Mount Sinai Health System, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mastrokostas","sequence":"additional","affiliation":[{"name":"SUNY Downstate Medical Centre College of Medicine, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Margetis","sequence":"additional","affiliation":[{"name":"Mount Sinai Health System, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"2026021110201852000_ip-2025-045888v1.1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s12519-011-0327-z","article-title":"Preventing motor vehicle crashes related spine injuries in children","volume":"7","author":"Rasouli","year":"2011","journal-title":"World J Pediatr"},{"key":"2026021110201852000_ip-2025-045888v1.2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2009.1153"},{"key":"2026021110201852000_ip-2025-045888v1.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000221802.83549.46"},{"key":"2026021110201852000_ip-2025-045888v1.4","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2021.0459"},{"key":"2026021110201852000_ip-2025-045888v1.5","doi-asserted-by":"publisher","DOI":"10.1148\/rg.233025121"},{"key":"2026021110201852000_ip-2025-045888v1.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181fbc69c"},{"key":"2026021110201852000_ip-2025-045888v1.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000103068.51037.20"},{"key":"2026021110201852000_ip-2025-045888v1.8","first-page":"113","article-title":"Vital signs: restraint use and motor vehicle occupant death rates among children aged 0-12 years - United States, 2002-2011","volume":"63","author":"Sauber-Schatz","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026021110201852000_ip-2025-045888v1.9","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1080\/15389588.2014.934959","article-title":"Motor Vehicle Crash\u2013Related Injury Causation Scenarios for Spinal Injuries in Restrained Children and Adolescents","volume":"15","author":"Zonfrillo","year":"2014","journal-title":"Traffic Inj Prev"},{"key":"2026021110201852000_ip-2025-045888v1.10","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/01.TA.0000113256.49300.2B","article-title":"Unusual seat-belt injuries in children","volume":"56","author":"Prince","year":"2004","journal-title":"J Trauma"},{"key":"2026021110201852000_ip-2025-045888v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.12.015"},{"key":"2026021110201852000_ip-2025-045888v1.12","first-page":"153","article-title":"Injury Mechanisms in the Pediatric Cervical Spine During Out-of-Position Airbag Deployments","volume":"42","author":"Nightingale","year":"1998","journal-title":"Annu Proc Assoc Adv Automot Med"},{"key":"2026021110201852000_ip-2025-045888v1.13","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1007\/s00414-024-03174-7","article-title":"Pediatric motor vehicle crashes injuries: A systematic review for forensic evaluation","volume":"138","author":"Giovannini","year":"2024","journal-title":"Int J Legal Med"},{"key":"2026021110201852000_ip-2025-045888v1.14","doi-asserted-by":"crossref","DOI":"10.1136\/wjps-2023-000703","article-title":"Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions","volume":"7","author":"Chen","year":"2024","journal-title":"World J Pediatr Surg"},{"key":"2026021110201852000_ip-2025-045888v1.15","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/15389588.2018.1529412","article-title":"Cervical and thoracic spine injury in pediatric motor vehicle crash passengers","volume":"20","author":"Mallory","year":"2019","journal-title":"Traffic Inj Prev"},{"key":"2026021110201852000_ip-2025-045888v1.16","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1097\/BRS.0000000000004072","article-title":"Seatbelts Save Lives, and Spines, in Motor Vehicle Accidents: A Review of the National Trauma Data Bank in the Pediatric Population","volume":"46","author":"Sarwahi","year":"2021","journal-title":"Spine (Phila Pa 1976)"},{"key":"2026021110201852000_ip-2025-045888v1.17","unstructured":"Trauma quality programs participant use file. ACS; 2025. Available: https:\/\/www.facs.org\/quality-programs\/trauma\/quality\/national-trauma-data-bank\/datasets\/"},{"key":"2026021110201852000_ip-2025-045888v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2026021110201852000_ip-2025-045888v1.19","unstructured":"Association for the Advancement of Automotive Medicine (AAAM) . The abbreviated injury scale 2005 revision. Barrington, IL Association for the Advancement of Automotive Medicine; 2005."},{"key":"2026021110201852000_ip-2025-045888v1.20","unstructured":"Association for the Advancement of Automotive Medicine (AAAM) . The abbreviated injury scale 2015 revision. Barrington, IL Association for the Advancement of Automotive Medicine; 2015."},{"key":"2026021110201852000_ip-2025-045888v1.21","unstructured":"Car seats and booster seats. NHTSA; 2025. Available: https:\/\/www.nhtsa.gov\/vehicle-safety\/car-seats-and-booster-seats"},{"key":"2026021110201852000_ip-2025-045888v1.22","doi-asserted-by":"crossref","DOI":"10.3171\/2016.1.FOCUS15612","article-title":"Pediatric sports-related traumatic brain injury in United States trauma centers","volume":"40","author":"Yue","year":"2016","journal-title":"Neurosurg Focus"},{"key":"2026021110201852000_ip-2025-045888v1.23","doi-asserted-by":"crossref","first-page":"550","DOI":"10.3171\/2022.6.JNS22466","article-title":"Equity in neurosurgery: a worldwide survey of women neurosurgeons","volume":"138","author":"Koutsouras","year":"2023","journal-title":"J Neurosurg"},{"key":"2026021110201852000_ip-2025-045888v1.24","first-page":"12","article-title":"Pediatric cervical spine injuries: report of 102 cases and review of the literature","volume":"92","author":"Eleraky","year":"2000","journal-title":"J Neurosurg"},{"key":"2026021110201852000_ip-2025-045888v1.25","first-page":"317","article-title":"Childhood injuries in Tehran: a review of 1281 cases","volume":"50","author":"Karbakhsh","year":"2008","journal-title":"Turk J Pediatr"},{"key":"2026021110201852000_ip-2025-045888v1.26","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.25665"},{"key":"2026021110201852000_ip-2025-045888v1.27","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.029223"},{"key":"2026021110201852000_ip-2025-045888v1.28","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1097\/BPO.0000000000000502","article-title":"The Effects of Restraint Type on Pattern of Spine Injury in Children","volume":"36","author":"Ernat","year":"2016","journal-title":"J Pediatr Orthop"},{"key":"2026021110201852000_ip-2025-045888v1.29","first-page":"1599","article-title":"Air bag-related deaths and serious injuries in children: injury patterns and imaging findings","volume":"19","author":"Marshall","year":"1998","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026021110201852000_ip-2025-045888v1.30","doi-asserted-by":"crossref","DOI":"10.1155\/2013\/168757","article-title":"Respiratory management in the patient with spinal cord injury","volume":"2013","author":"Galeiras V\u00e1zquez","year":"2013","journal-title":"Biomed Res Int"},{"key":"2026021110201852000_ip-2025-045888v1.31","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1038\/s41394-020-00371-5","article-title":"Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India","volume":"7","author":"Sengupta","year":"2021","journal-title":"Spinal Cord Ser Cases"},{"key":"2026021110201852000_ip-2025-045888v1.32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1055\/s-0035-1554986","article-title":"Pediatric Spinal Cord Injury: Recognition of Injury and Initial Resuscitation, in Hospital Management, and Coordination of Care","volume":"4","author":"Lemley","year":"2015","journal-title":"J Pediatr Intensive Care"},{"key":"2026021110201852000_ip-2025-045888v1.33","doi-asserted-by":"crossref","first-page":"106995","DOI":"10.1016\/j.aap.2023.106995","article-title":"Impact of COVID-19 on traffic safety from the \u201cLockdown\u201d to the \u201cNew Normal\u201d: A case study of Utah","volume":"184","author":"Gong","year":"2023","journal-title":"Accid Anal Prev"},{"key":"2026021110201852000_ip-2025-045888v1.34","doi-asserted-by":"crossref","first-page":"1001567","DOI":"10.3389\/fpubh.2022.1001567","article-title":"Injury mortality and morbidity changes due to the COVID-19 pandemic in the United States","volume":"10","author":"He","year":"2022","journal-title":"Front Public Health"},{"key":"2026021110201852000_ip-2025-045888v1.35","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1177\/00031348211047466","article-title":"Increase in Motor Vehicle Crash Severity: An Unforeseen Consequence of COVID-19","volume":"89","author":"Kaufman","year":"2023","journal-title":"Am Surg"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2025-045888","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:20:26Z","timestamp":1770834026000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2025-045888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":35,"alternative-id":["10.1136\/ip-2025-045888"],"URL":"https:\/\/doi.org\/10.1136\/ip-2025-045888","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]}}}