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Published on: April 1, 2019
Predictors of pediatric blunt cerebrovascular injury
Avery C Rossidis1, Sasha J Tharakan1, Sourav K Bose2
1Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Adult screening criteria for blunt cerebrovascular injury (BCVI) are effective in children, but most at-risk pediatric patients are not screened. Identifying risk factors like cervical spine fractures is crucial for early detection and intervention in pediatric trauma.
Area of Science:
- Trauma Surgery
- Pediatric Neurosurgery
- Vascular Surgery
Background:
- Blunt cerebrovascular injury (BCVI) in children presents diagnostic challenges and significant neurological risks.
- Optimal screening criteria for pediatric BCVI remain undefined.
- Early detection is critical due to potential severe neurological consequences.
Purpose of the Study:
- To identify independent risk factors for BCVI in pediatric blunt trauma patients.
- To evaluate the effectiveness of current screening practices for pediatric BCVI.
- To assess the applicability of adult screening criteria to pediatric populations.
Main Methods:
- Retrospective review of pediatric blunt trauma patients over a 10-year period.
- Analysis of demographic, clinical, and radiographic data, including adult BCVI risk factors.
- Logistic regression analysis to determine independent risk factors (p<0.05).
Main Results:
- Out of 11,596 patients, 1018 (8.8%) had adult risk factors, but only 6.1% were screened.
- Eleven cases of BCVI (0.095% incidence) were identified, all in patients with at least one risk factor.
- Independent risk factors included cervical spine fracture, GCS ≤ 8, male gender, Le Fort II/III facial fracture, and ISS.
Conclusions:
- Established adult screening criteria for BCVI are suitable for pediatric patients.
- A significant gap exists in screening at-risk pediatric patients for BCVI.
- Improved adherence to screening protocols is necessary to reduce BCVI-related morbidity.
Background/Purpose:
Blunt cerebrovascular injury (BCVI) is clinically challenging because these injuries are hard to detect and can have serious neurological consequences, and optimal screening criteria have not been established for children. This study aims to determine risk factors for BCVI in pediatric patients and to evaluate screening practices in a single institutional series.
Methods:
A retrospective review of all pediatric blunt trauma patients evaluated over a 10-year period was performed. Demographic, clinical, and radiographic data were reviewed, including the presence of adult risk factors for BCVI. Logistic regression analyses were performed with statistical significance established at p<0.05.
Results:
Of the 11,596 patients evaluated during the study period, 1018 (8.8%) had at least one adult risk factor for BCVI, but only 62 (6.1% of those with risk factors) underwent angiographic evaluation. Overall, 11 BCVIs were observed, resulting in an incidence of 0.095%. All 11 patients with BCVI had at least one risk factor. Multivariate logistic regression analysis identified cervical spine fracture (OR 36.88 [8.36, 169.95]), GCS score ≤ 8 (OR 16.42 [2.16, 102.33]), male gender (OR 10.52 [1.33, 363.30]), Le Fort II or III facial fracture (OR 63.71 [2.16, 1124.68]), and ISS (unit OR 1.10 [1.04, 1.17]) as independent risk factors for BCVI.
Conclusion:
Adult screening criteria for BCVI appear appropriate for pediatric patients, but most at-risk children are not being screened.
Level Of Evidence:
Level III (retrospective case-control study).
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