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Multi-Center Validation of the McGovern Pediatric Blunt Cerebrovascular Injury Screening Score
Sidish S Venkataraman1, Joseph P Herbert2, Vijay M Ravindra3
1Department of Neurosurgery, Wake Forest Medical School, Winston-Salem, North Carolina, USA.
Insights
The McGovern score effectively identifies children at high risk for blunt cerebrovascular injury (BCVI), a serious condition from head and neck trauma. This validated tool demonstrates high sensitivity and negative predictive value for diagnosing BCVI in pediatric patients.
Area of Science:
- Pediatric Trauma Care
- Vascular Imaging
- Emergency Medicine
Background:
- Blunt cerebrovascular injury (BCVI) diagnosis in children lacks standardized high-risk criteria.
- Accurate identification of at-risk pediatric trauma patients is crucial for timely intervention.
Purpose of the Study:
- To validate the McGovern score as a screening tool for identifying pediatric patients at high risk for BCVI.
- To assess the generalizability of the McGovern score across multiple trauma centers.
Main Methods:
- Multi-center, hospital-based cohort study of pediatric (<16 years) trauma patients (2003-2017).
- Retrospective query of CT angiogram (CTA) data for BCVI screening.
- Analysis of patient demographics, injury mechanisms, neurological status, and radiological findings.
Main Results:
- The McGovern score demonstrated over 80% sensitivity and over 98% negative predictive value for BCVI across all data groups.
- The validation cohort included 51 patients with confirmed BCVI.
Conclusions:
- The McGovern score is an effective and generalizable screening tool for pediatric blunt cerebrovascular injury.
- This validated score aids in identifying children who require further vessel imaging.
Abstract:
Blunt cerebrovascular injury (BCVI) is defined as blunt trauma to the head and neck leading to damage to the vertebral and/or carotid arteries; debate exists regarding which children are considered at high risk for BCVI and in need of angiographic/vessel imaging. We previously proposed a screening tool, the McGovern score, to identify pediatric trauma patients at high risk for BCVI, and we aim to validate the McGovern score by pooling data from multiple pediatric trauma centers. This is a multi-center, hospital-based, cohort study from all prospectively registered pediatric (<16 years of age) trauma patients who presented to the emergency department (ED) between 2003 and 2017 at six Level 1 pediatric trauma centers. The registry was retrospectively queried for patients who received a computed tomography angiogram (CTA) as a screening method for BCVI. Age, length of follow-up, mechanism of injury (MOI), arrival Glasgow Coma Scale (GCS) score, and focal neurological deficit were recorded. Radiological variables queried were the presence of a carotid canal fracture, petrous temporal bone fracture, and CT presence of infarction. Patients with BCVI were queried for mode of treatment, type of intracranial injury, artery damaged, and BCVI injury grade. The McGovern score was calculated for all patients who underwent CTA across all data groups. A total of 1012 patients underwent CTA; 72 of these patients were found to have BCVI, 51 of which were in the validation cohort. Across all data groups, the McGovern score has a >80% sensitivity (SN) and >98% negative predictive value (NPV). The McGovern score for pediatric BCVI is an effective, generalizable screening tool.
