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. 2024 Apr 24;50(1):86.
doi: 10.1186/s13052-024-01653-6.

Pediatric torticollis: clinical report and predictors of urgency of 1409 cases

Umberto Raucci  1   2 , Marco Roversi  3   4 , Alessandro Ferretti  5 , Valerio Faccia  5 , Giacomo Garone  5   6 , Fabio Panetta  7 , Carlo Mariani  8 , Eloisa Rizzotto  8 , Antonio Torelli  8 , Giovanna Stefania Colafati  9 , Angelo Gabriele Aulisa  10   11 , Pasquale Parisi  5 , Alberto Villani  7   12
Affiliations

Pediatric torticollis: clinical report and predictors of urgency of 1409 cases

Umberto Raucci et al. Ital J Pediatr. .

Abstract

Background: To date, the etiology and risk factors of torticollis are still poorly defined in the pediatric literature. Especially in the Emergency Department (ED) scenario, it is critical to reliably distinguish benign and transient conditions from (potentially) life-threatening disorders. This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and predictive variables associated with a higher risk of life-threatening conditions in acute torticollis.

Methods: We conducted a pediatric retrospective study of acute torticollis over a 13-year period referred to the ED of a tertiary pediatric Hospital. We reported the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we developed a multivariate model aimed at identifying the main clinical predictors of the need for urgent care.

Results: 1409 patients were analyzed (median age 5.7 years, IQR 5.8). A history of trauma was present in 393 patients (27.9%). The symptom most frequently associated with torticollis were pain (83.5%). At least one pathological finding was found in 5.4 to 7.9% of patients undergoing further imaging. Hospitalization was required in 11.1% of cases (median duration 4 days). The most frequent etiologies of torticollis were postural cause (43.1%), traumatic (29.5%), and infective/inflammatory (19.1%). A longer time from onset of torticollis and the presence of headache or vomiting were strongly correlated with an underlying urgent condition, after adjusting for the other clinically and statistically significant variables in the bivariate analysis.

Conclusion: Our study shows that an urgent condition most commonly occur in patients presenting with history of trauma or headache, vomiting and torticollis for more than 24 h should undergo further diagnostic evaluation and short-term follow-up, restricting invasive or expensive investigations to patients with clinical suspicion of an underlying harmful condition.

Keywords: Children; Emergency; Pediatrics, Neck complaints; Torticollis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Proposed algorithm for torticollis
See this image and copyright information in PMC

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