Emergency Department Predictors of Mechanical Ventilation in Pediatric Spine Fracture Patients in the US

Study DesignRetrospective cohort study.ObjectivesTo identify emergency department variables associated with mechanical ventilation among pediatric patients with spine fractures and characterize outcomes by ventilation duration.MethodsWe queried the National Trauma Data Bank from 2017 to 2022 for patients younger than 18 years with cervical, thoracic, or lumbar vertebral fractures. The primary outcome was mechanical ventilation during hospitalization. Thirty-five ED-available predictors were entered into multivariable logistic regression. Discrimination was assessed using the C-statistic, and robustness was tested across 14 prespecified sensitivity and subgroup models. Secondary outcomes were compared across no ventilation, 1 ventilator day, and 2 or more ventilator days.ResultsAmong 29,024 patients, 5,831 (20.1%) received mechanical ventilation. Severe neurologic impairment was the dominant predictor: GCS ≤8 had an adjusted odds ratio (aOR) of 190.52, and GCS 9-12 had an aOR of 15.18. Other independent risk factors included hypotension, penetrating trauma, hypothermia, hypoxemia, shock index ≥0.9, and air transport. Thoracic and lumbar fractures, private vehicle arrival, female sex, interfacility transfer, and helmet use were associated with lower odds. Model discrimination was excellent (C-statistic, 0.928), with consistent performance across sensitivity analyses (C-statistics, 0.916-0.940). Prolonged ventilation occurred in 5,081 patients (17.5%) and was associated with 15.7% mortality, 99.0% ICU admission, median hospital length of stay of 15 days, and higher complication rates.ConclusionsED GCS, physiologic instability, respiratory compromise, and cervical fracture location identified pediatric spine fracture patients at higher risk for mechanical ventilation. Early recognition may support triage, airway planning, ICU allocation, and family counseling.