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Blunt cerebrovascular injury in pediatric trauma: a national database study
Dominic A Harris1, Danielle E Sorte1, Sandi K Lam2
11Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; and.
Insights
The incidence of blunt cerebrovascular injury (BCVI) in children is rising, with fractures and head injuries as key risk factors. This condition is linked to increased stroke risk and mortality, necessitating further research into treatment.
Area of Science:
- Trauma Surgery
- Pediatric Neurology
- Vascular Surgery
Background:
- Blunt cerebrovascular injury (BCVI) is not well-characterized in pediatric trauma.
- Understanding incidence and risk factors is crucial for this population.
Purpose of the Study:
- To determine the incidence of BCVI in pediatric patients.
- To identify patient characteristics and risk factors associated with pediatric BCVI.
Main Methods:
- Analysis of the Kids' Inpatient Database (KID) from 2000-2012.
- Inclusion of pediatric admissions for blunt trauma.
Main Results:
- BCVI incidence increased from 0.24% to 0.49% between 2000 and 2012.
- Associated factors include cervical, skull base, clavicular, and facial fractures, TBI, and intracranial hemorrhage.
- Pediatric BCVI patients had a 37.4% stroke rate and 12.7% in-hospital mortality.
Conclusions:
- Pediatric BCVI incidence is increasing, with risk factors similar to adults.
- BCVI in children is associated with significant stroke risk, morbidity, and mortality.
- Adult screening criteria may be applicable; further research on antiplatelet/anticoagulation therapy is warranted.
Objective:
The incidence of blunt cerebrovascular injury (BCVI) has not been well characterized in the pediatric population. The goal of this study was to describe the incidence, patient characteristics, and risk factors for pediatric patients with cerebrovascular injuries.
Methods:
The authors collected data from the Kids' Inpatient Database (KID), a nationally representative database of pediatric admissions, for years 2000, 2003, 2006, 2009, and 2012.
Results:
Among an estimated 646,549 admissions for blunt trauma, 2150 were associated with BCVI, an overall incidence of 0.33%. The incidence of BCVI nearly doubled from 0.24% in 2000 to 0.49% in 2012. Patients 4 to 13 years of age were less likely to have BCVI than those in the youngest (0-3 years) and oldest age groups comprising adolescents (14-17 years) and young adults (18-20 years). BCVIs were associated with cervical (adjusted OR [aOR] 4.6, 95% CI 3.8-5.5), skull base (aOR 3.0, 95% CI 2.5-3.6), clavicular (aOR 1.4, 95% CI 1.1-1.8), and facial (aOR 1.2, 95% CI 1.0-1.5) fractures, as well as intracranial hemorrhage (aOR 2.7, 95% CI 2.2-3.2) and traumatic brain injury (aOR 2.0, 95% CI 1.7-2.3). Mechanism of injury was also independently associated with BCVI: motor vehicle collision (aOR 1.7, 95% CI 1.3-2.2) and struck pedestrian (aOR 1.4, 95% CI 1.0-1.9). Among pediatric patients with BCVI, 37.4% had cerebral ischemic infarction with an in-hospital mortality of 12.7%, and patients with stroke had 20% mortality.
Conclusions:
The incidence of pediatric BCVI is increasing, likely due to increased use of screening, but remains lower than that in the adult population. Risk factors include the presence of cervical, facial, clavicular, and skull base fractures, similar to that of the adult population. Diagnosed BCVI is associated with a relatively high incidence of stroke with increased morbidity and mortality. The use of adult screening criteria is likely reasonable given the similarity in the risk factors identified in this study. Further studies are needed to investigate the role of treatment with antiplatelet agents or anticoagulation.
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