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A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries

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Abstract

Despite being relatively rare, pediatric traumatic spinal cord injury (TSCI) is a debilitating event with high morbidity and long-term damage and dependency. This study aims to provide insight on the epidemiological characteristics of pediatric TSCI worldwide. The studies were included if they provided data for the pediatric population with the diagnosis of TSCI. Information sources included PubMed, Embase, Web of Science, and Scopus. All databases were searched from 1990 to April 2023. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. The results of the meta-analysis were presented as forest plots. PROSPERO Registration code: CRD42020189757. We identified 87 studies from 18 developed and 11 developing countries. Of the 87 studies evaluated, 52 studies were considered medium quality, 27 studies were considered high quality, and 8 studies were considered low quality. In developed countries, the proportion of TSCIs occurring in patients aged 0–15 years was 3% (95% CI: 2.2%; 3.9%), while in developing countries, it was 4.5% (95% CI: 2.8%; 6.4%). In developed countries, the pooled incidence of pediatric TSCI was 4.3/millions of children aged 0–15/year (95% CI: 3.1; 6.0/millions children aged 0–15/year) and boys comprised 67% (95% CI: 63%; 70%) of cases. The most prevalent level of injury was cervical (50% [95% CI: 41%; 58%]). The frequency of SCI Without Obvious Radiological Abnormality (SCIWORA) was 35% (95% CI: 18%; 54%) among children 0–17 years. The most common etiology in developed countries was transport injuries (50% [95% CI: 42%; 57%]), while in developing countries falls were the leading cause (31% [95% CI: 20%; 42%]). The most important limitation of our study was the heterogeneity of studies in reporting age subgroups that hindered us from age-specific analyses.

   Conclusion: Our study provided accurate estimates for the epidemiology of pediatric TSCI. We observed a higher proportion of pediatric TSCI cases in developing countries compared to developed countries. Furthermore, we identified distinct epidemiological characteristics of pediatric TSCI when compared to adult cases and variations between developing and developed countries. Recognizing these unique features allows for the implementation of cost-effective preventive strategies aimed at reducing the incidence and burden of TSCI in children.

What is Known:

• Pediatric Traumatic Spinal Cord Injury (TSCI) can have profound physical and social consequences for affected children, their families, and society as a whole.

• Epidemiological insights are vital for they provide the data and understanding needed to the identification of vulnerable populations, aiding in the development of targeted prevention strategies and effective resource allocation.

What is New:

• The estimated incidence of pediatric TSCI in developed countries is 4.3 cases per million children aged 0-15. The proportion of pediatric TSCI cases in relation to all-age TSCI cases is 3% in developed countries and 4.5% in developing countries.

• The etiology of TSCI in pediatric cases differs between developing and developed countries. In developed countries, transport injuries are the most prevalent cause of pediatric TSCI, while falls are the least common cause. Conversely, in developing countries, falls are the leading cause of pediatric TSCI.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to express our gratitude to Dr. Rasoul Masoomi for his valuable assistance in updating our search.

Funding

This work was funded by Tehran University of Medical Sciences, [grant number is 99-2-93-49831].

Author information

Authors and Affiliations

  1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Behnam Jazayeri, Samuel Berchi Kankam, Ali Golestani, Mohammad Amin Dabbagh Ohadi, Seyed Farzad Maroufi, Mohammad Reza Fattahi, Hamid Malekzadeh, Zahra Ghodsi, Seyed Mohammad Ghodsi & Vafa Rahimi-Movaghar

  2. International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Samuel Berchi Kankam

  3. School of Medicine, Tehran University of Medical Science, Tehran, Iran

    Parnian Shobeiri

  4. Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular, Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Morteza Gholami

  5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical, Tehran, Iran

    Morteza Gholami

  6. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Reza Fattahi, Zahra Ghodsi, Seyed Mohammad Ghodsi & Vafa Rahimi-Movaghar

  7. Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Mohammad Reza Fattahi & Vafa Rahimi-Movaghar

  8. Department of Urology, University of Florida, Jacksonville, FL, 32209, USA

    Seyed Behzad Jazayeri

  9. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Vafa Rahimi-Movaghar

  10. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran

    Vafa Rahimi-Movaghar

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  1. Seyed Behnam Jazayeri
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  2. Samuel Berchi Kankam
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  3. Ali Golestani
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  7. Seyed Farzad Maroufi
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  8. Mohammad Reza Fattahi
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  10. Seyed Behzad Jazayeri
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  12. Seyed Mohammad Ghodsi
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  13. Vafa Rahimi-Movaghar
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Contributions

VRM and SMG conceived the presented idea and supervised the project. ZG provided critical feedback and edited the draft. MRF, SFM, MADO and SBJ contributed to data collection. HM, SBK and SBJ contributed to quality appraisal. AG and PS analyzed the data and SBJ wrote the draft. SBJ and AG contributed to data interpretation. MG performed the search. All authors discussed the results and contributed to finalizing the manuscript.

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Correspondence to Seyed Mohammad Ghodsi or Vafa Rahimi-Movaghar.

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The Ethics Committee of Tehran University of Medical Sciences approved the study, and the reference number is IR.TUMS.SINAHOSPITAL.REC.1400.001.

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The authors announce that there is no competing of interests.

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Communicated by Gregorio Milani

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Jazayeri, S.B., Kankam, S.B., Golestani, A. et al. A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries. Eur J Pediatr 182, 5245–5257 (2023). https://doi.org/10.1007/s00431-023-05185-9

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