Epidemiology of brachial plexus injury in the pediatric multitrauma population in the United States

Dorsi, Michael J.; Hsu, Wesley; Belzberg, Allan J.

doi:10.3171/2010.3.peds09538

Cited by 34 publications

(27 citation statements)

References 21 publications

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“…Although, this prevalence is lower than what has been reported for the adult population, 11,14 it is significantly higher than what previous studies have found for children. 3 This higher rate is probably the result of the comprehensive nature of NTDB and rigorous data collection.…”

Section: Discussionmentioning

confidence: 99%

“…This pattern is consistent with findings of prior studies of both adults and children. 3,11,14 The improved granularity of NTDB enabled us to identify motorcycle crashes as more frequent contributors to this injury, in comparison with motor vehicle crashes. The combination of high-speed travel and limited protection for motorcycle riders results in crashes with frequent ejections and high kinetic energy.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics

Missios

Bekelis

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2014

PED

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Object Despite the negative effects of peripheral nerve injuries (PNIs) on long-term population health, their true prevalence among pediatric trauma patients is under debate. The authors investigated the prevalence of PNIs among children involved in trauma and investigated associations between PNIs and several patient characteristics. Methods The authors performed a retrospective cohort study of pediatric trauma patients who were registered in the National Trauma Data Bank from 2009 through 2011 and who fulfilled the study inclusion criteria. They used regression techniques to investigate the association of demographic and socioeconomic factors with the rate of PNIs among these patients. Results Of the 245,470 study patients, 50,211 were involved in motor vehicle crashes, 3380 in motorcycle crashes, 20,491 in bicycle crashes, 18,262 in pedestrian accidents, 26,294 in other crashes (mainly involving all-terrain vehicles and snowmobiles), and 126,832 in falls. The respective prevalence of PNIs was 0.66% for motor vehicle crashes, 1% for motorcycle crashes, 0.38% for bicycle crashes, 0.42% for pedestrian accidents, 0.79% for other crashes, and 0.52% for falls. Multivariate logistic regression analysis demonstrated that the following were associated with an increased incidence of PNIs: increased patient age (OR 1.10, 95% CI 1.01–1.20), higher Injury Severity Score (OR 1.10, 95% CI 1.01–1.20), elevated systolic blood pressure at arrival at the emergency room (OR 1.10, 95% CI 1.01–1.20), and increased number of trauma surgeons at the institution (OR 1.10, 95% CI 1.01–1.20). The following were associated with lower incidence of PNIs: female sex (OR 0.94, 95% CI 0.87–1.02), rural hospitals (OR 0.94, 95% CI 0.87–1.02), and urban nonteaching hospitals (OR 0.94, 95% CI 0.87–1.02). Conclusions PNIs are more common than previously identified for the pediatric trauma population. These injuries are associated with older age and increased severity of the overall injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics

Missios

Bekelis

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2014

PED

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“…This pattern is consistent with prior literature associating PNIs with high-speed collisions. 7,19,21 Multilevel falls followed in incidence, with ground-level falls being the most rare. The understanding that PNIs can appear with any type of fall will make clinicians more vigilant to diagnose these often occult injuries and protect their patients from secondary complications.…”

Section: Discussionmentioning

confidence: 99%

“…E-codes 833. 7 were eligible for inclusion. Exclusion criteria consisted of patients who were dead on arrival to the emergency department, and incomplete record information on mechanism of injury and age.…”

Section: Cohort Definitionmentioning

confidence: 99%

“…Several authors 18 have shown the prevalence of birth-related PNIs to be around 0.1%. Dorsi et al, 7 in a registry study, identified PNIs in 0.1% of trauma victims younger than 20 years old. These analyses did not focus on fall-injured patients, were limited by selection bias, and were lacking adjustment for the physiological characteristics of this patient population.…”

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confidence: 99%

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Falls and peripheral nerve injuries: an age-dependent relationship

Bekelis

Missios

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2015

JNS

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obJect Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown. methods The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated. results Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex ) and ground-level falls ) were associated with a lower rate of PNIs. coNclusioNs Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.

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Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: Case report

Dorsi

Belzberg

2011

Microsurgery

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Transverse myelitis (TM) may result in permanent neurologic dysfunction. Nerve transfers have been developed to restore function after peripheral nerve injury. Here, we present a case report of a child with permanent right upper extremity weakness due to TM that underwent nerve transfers. The following procedures were performed: double fascicle transfer from median nerve and ulnar nerve to the brachialis and biceps branches of the musculocutaneous nerve, spinal accessory to suprascapular nerve, and medial cord to axillary nerve end-to-side neurorraphy. At 22 months, the patient demonstrated excellent recovery of elbow flexion with minimal improvement in shoulder abduction. We propose that the treatment of permanent deficits from TM represents a novel indication for nerve transfers in a subset of patients.

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Epidemiology of brachial plexus injury in the pediatric multitrauma population in the United States

Cited by 34 publications

References 21 publications

Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics

Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics

Falls and peripheral nerve injuries: an age-dependent relationship

Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: Case report

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