Diagnostic Errors of Spinal Cord Injuries in Children with Combined Trauma on the example of Clinical Cases

Abstract

Diagnostic errors of spinal cord injuries with combined trauma in children are facilitated by the patient’s age, which does not allow foran adequate neurological assessment of motor and sensitive disorders, a reduced state of consciousness in severe traumatic brain injury,the lack of modern methods of neuroimaging in primary hospitals, insufficient qualifications and experience of medical personnel. Aim. To demonstrate outcomes of diagnostic errors in traumatic spinal cord injury in children on clinical examples of two patients. Material and methods. The object of observation was children with severe combined trauma, whose post-traumatic spinal cord injurywas missed in the primary hospital. To diagnose the current condition, the following were used: clinical examination with a neurologicalassessment on the ASIA scale, assessment of motor functioning, laboratory monitoring, instrumental examination, ultrasoundmonitoring, X-ray, MRI, CT, CT densitometry, ECG, echocardiography, USDG. In addition, neuropsychological assessment was made so to evaluate cortical functions and to reveal consequences of traumatic brain injury. Results. The cause of errors in the diagnostics of spinal cord injury in children is the underestimation of state severity due to the combinedtype of injury or small age of the child. Conclusion. The experience of the multidisciplinary team of specialists in the diagnosis and medical rehabilitation of children withspinal cord injury missed in the primary hospital indicates the need to conduct a full-fledged neurological examination, CT accordingto the “head to toe” program and MRI, even if there is a slight suspicion of the spinal cord damage.Underestimation of the severity of the child’s condition with concomitant trauma, including spinal cord injury, leads to the deprivationnot only in the motor function restoration, but also to deterioration in the quality of life of the family and to the problems associatedwith patient’s integration into society.

Keywords

• clinical case
• combined trauma
• spinal cord injury
• sciwora syndrome
• medical rehabilitation