Chair of Neurosurgery University of Miami Miami, FL, US
Introduction: Pediatric Type 2 dens fractures are rare, classically occurring in the setting of trauma. Although the role of surgical stabilization remains debated, the index clinical course and disposition after diagnosis in the pediatric niche remain poorly defined. Correspondingly, we sought to define the inpatient outcomes of these patients and compare them based on surgical intervention.
Methods: The Nationwide Inpatient Sample (NIS) database between 2016-2020 was retrospectively interrogated for all pediatric (aged ≤ 18 years) presenting with Type 2 dens fractures. Quantitative data were compared using weighted statistics, and disposition outcomes were modeled using regression analyses.
Results: A total of 500 pediatric patients satisfied all criteria for selection. Mean age was 12.3 years, with majority of patients being male, Caucasian, with traumatic injuries. There were 100 (20%) patients who underwent surgical stabilization of the cervical spine due to the Type 2 dens fracture. At presentation, compared to non-surgical patients, surgical patients had a statistically distinct socioeconomic profile. In terms of inpatient course, surgical patients were more likely to experience multiple medical complications, and more likely to undergo intubation and percutaneous enteral gastrostomy placement procedures (all P< 0.001). Ultimately, surgical patients did not experience any inpatient mortality with comparable discharge to home rates as non-surgical patients. They did however experience significantly longer lengths of stay (LOS, P=0.011) and greater total hospital charges (P=0.002). Multivariate regression analyses found significant associations with surgical treatment during inpatient stay to be the need for intubation (OR 4.60, P=0.007) and PEG placement (OR 7.89, P=0.022), and conversely, patients from the South compared to the Northeast (OR 0.17, P=0.037) were associated with less surgical treatment.
Conclusion : The subset of pediatric Type 2 dens fractures treated by surgical stabilization possess a distinct socioeconomic profile, traumatic presentation, and inpatient clinical course when compared to non-surgical patients with the same diagnosis. Surgical patients experience greater complications and number of procedures, of associated with greater rates of surgical treatment, as well as leading to greater LOS and total charges.
