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Predicting Blunt Cerebrovascular Injury in Pediatric Trauma: Validation of the "Utah Score"
Vijay M Ravindra1, Robert J Bollo1, Walavan Sivakumar1
11 Department of Neurosurgery, University of Utah School of Medicine ; Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah.
Insights
The Utah Score effectively predicts blunt cerebrovascular injury (BCVI) in pediatric trauma patients. This validated score may reduce unnecessary computed tomography angiography (CTA) and radiation exposure in low-risk children.
Area of Science:
- Pediatric Traumatology
- Vascular Imaging
- Radiology
Background:
- Blunt cerebrovascular injury (BCVI) risk factors differ between pediatric and adult populations.
- Current screening via computed tomography angiography (CTA) exposes children to high radiation doses.
- Previous development of a predictive score for pediatric BCVI warrants external validation.
Purpose of the Study:
- To externally validate a previously developed prediction score (the "Utah Score") for pediatric BCVI.
- To assess the score's accuracy in a multi-institutional cohort of pediatric trauma patients.
- To determine if the score can identify low-risk patients eligible for reduced imaging.
Main Methods:
- Retrospective multi-institutional cohort study involving four pediatric Level I trauma centers.
- Inclusion criteria: patients undergoing CTA for traumatic cranial injury.
- Application of the "Utah Score" to classify patients as high or low risk for BCVI.
Main Results:
- A total of 645 patients (411 in validation cohort) were analyzed; 5.4% had BCVI.
- The Utah Score was significantly associated with BCVI (OR 8.1, p < 0.001) with an AUC of 72%.
- The score demonstrated high sensitivity (59%), specificity (85%), and negative predictive value (97%), with a misclassification rate of 16.6%.
Conclusions:
- The Utah Score is validated for predicting BCVI in pediatric trauma patients.
- The score accurately identifies patients at low risk, potentially reducing unnecessary CTA.
- Clinical implementation could optimize imaging protocols and minimize radiation exposure in children.
Abstract:
Risk factors for blunt cerebrovascular injury (BCVI) may differ between children and adults, suggesting that children at low risk for BCVI after trauma receive unnecessary computed tomography angiography (CTA) and high-dose radiation. We previously developed a score for predicting pediatric BCVI based on retrospective cohort analysis. Our objective is to externally validate this prediction score with a retrospective multi-institutional cohort. We included patients who underwent CTA for traumatic cranial injury at four pediatric Level I trauma centers. Each patient in the validation cohort was scored using the "Utah Score" and classified as high or low risk. Before analysis, we defined a misclassification rate <25% as validating the Utah Score. Six hundred forty-five patients (mean age 8.6 ± 5.4 years; 63.4% males) underwent screening for BCVI via CTA. The validation cohort was 411 patients from three sites compared with the training cohort of 234 patients. Twenty-two BCVIs (5.4%) were identified in the validation cohort. The Utah Score was significantly associated with BCVIs in the validation cohort (odds ratio 8.1 [3.3, 19.8], p < 0.001) and discriminated well in the validation cohort (area under the curve 72%). When the Utah Score was applied to the validation cohort, the sensitivity was 59%, specificity was 85%, positive predictive value was 18%, and negative predictive value was 97%. The Utah Score misclassified 16.6% of patients in the validation cohort. The Utah Score for predicting BCVI in pediatric trauma patients was validated with a low misclassification rate using a large, independent, multicenter cohort. Its implementation in the clinical setting may reduce the use of CTA in low-risk patients.
