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Updated: Jan 5, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Analysis of blunt cerebrovascular injury in pediatric trauma
Areg Grigorian1, Matthew Dolich, Michael Lekawa
1From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (A.G., M.D., M.L., R.M.F., N.-K.K., R.B., J.N.), University of California, Irvine, Orange; and Department of Anesthesia (C.M.K.), University of Southern California, Los Angeles, California.
Insights
Blunt cerebrovascular injury (BCVI) in children is rare. Skull base fractures, cervical spine fractures, and intracranial hemorrhage are key risk factors, while motor vehicle accidents are not independent predictors.
Area of Science:
- Pediatric Traumatology
- Vascular Surgery
- Emergency Medicine
Background:
- Blunt cerebrovascular injury (BCVI) is uncommon in pediatric patients, affecting less than 1%.
- Current screening relies on criteria like the Utah and McGovern Scores, with motor vehicle accidents (MVAs) previously considered a predictor.
- This study aimed to validate known risk factors and discover new associations for BCVI in children.
Purpose of the Study:
- To identify and confirm independent risk factors for blunt cerebrovascular injury (BCVI) in pediatric patients.
- To evaluate the predictive value of motor vehicle accidents (MVAs) in pediatric BCVI screening.
- To provide data for refining screening protocols for BCVI in children.
Main Methods:
- Analysis of the Pediatric Trauma Quality Improvement Program database (2014-2016).
- Inclusion of patients under 16 years old presenting with blunt trauma.
- Multivariable logistic regression used to determine BCVI risk factors.
Main Results:
- Out of 69,149 pediatric patients, 109 (0.2%) were diagnosed with BCVI.
- Strong independent predictors for BCVI included skull base fracture (OR 3.84), cervical spine fracture (OR 3.15), intracranial hemorrhage (OR 3.11), and GCS ≤ 8 (OR 2.11).
- Motor vehicle accident was not found to be an independent predictor (p=0.07).
Conclusions:
- Skull base fracture is the most significant risk factor for pediatric BCVI.
- Cervical spine and mandible fractures are also associated with pediatric BCVI.
- Motor vehicle accidents are not independent predictors, necessitating a re-evaluation of screening criteria.
Background:
Blunt cerebrovascular injury (BCVI) occurs in <1% of pediatric patients. The two principal screening criteria for BCVI in children are the Utah and McGovern Score with motor vehicle accident (MVA) considered to be a predictor for BCVI. We sought to confirm previously reported risk factors and identify novel associations with BCVI in pediatric patients.
Methods:
The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients younger than 16 years presenting after blunt trauma. A multivariable logistic regression was used to determine risk of BCVI.
Results:
From 69,149 pediatric patients, 109 (<0.2%) had BCVI. The median age was 13 years, and the median Injury Severity Score was 25. More than half the patients were involved in MVAs (53.2%) and had a skull base fracture (53.2%). Factors independently associated with BCVI include skull base fracture (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.40-6.14; p < 0.001), cervical spine fracture (OR, 3.15; 95% CI, 1.91-5.18; p < 0.001), intracranial hemorrhage (OR, 3.11; 95% CI, 1.89-5.14; p < 0.001), Glasgow Coma Scale score of 8 or less (OR, 2.11; 95% CI, 1.33-3.54; p = 0.003), and mandible fracture (OR, 1.99; 95% CI, 1.05-3.84; p = 0.04). Motor vehicle accident was not an independent predictor for BCVI (p = 0.07).
Conclusion:
In the largest analysis of pediatric BCVI to date, skull base fracture had the strongest association with BCVI. Other associations to pediatric BCVI included cervical spine and mandible fracture. Motor vehicle accident, previously identified to be associated with BCVI, was not an independent risk factor in our analysis. A future multicenter study incorporating newly identified variables in a scoring system to screen for BCVI is warranted.
Level Of Evidence:
Level IV (Prognostic/Epidemiologic).
