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Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson's chi-squared or Fisher's exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p=0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.
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BACKGROUND: Health care providers can play an important role in detection of intimate partner violence within health services but barriers exist. AIMS: This study aimed to determine the barriers that health care providers in Fayoum, Egypt, consider prevent them from screening for intimate partner violence. METHODS: This was a cross-sectional study between June 2018 and January 2019. The sample was health care providers (doctors, nurses, social workers and community workers) selected from government primary care centres in all seven districts of Fayoum. A validated Arabic version of the Domestic Violence Health Care Provider Survey was used to collect data. RESULTS: A total of 385 health care providers (92.7% women) agreed to participate (78.6% response rate). Just over half of the participants did not have access to social workers or community workers or strategies to help victims of intimate partner violence. None had received training on screening for domestic violence. More than half (59.7%) thought that investigating the cause of intimate partner violence was not part of medical practice. Sex was significantly associated with perceived self-efficacy, while age and occupation were significantly associated with referral management and health providers' attitude. CONCLUSION: Primary health care providers perceived many barriers to screening for intimate partner violence. Training on screening for and managing intimate partner violence should be part of the professional development for all health care providers. An effective referral system is needed that ensures comprehensive services for victims.