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Blunt Cerebrovascular Injury in Pediatric Hanging Victims
Alena A Golubkova1, Heather L Liebe1, Tyler D Leiva1
1Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Insights
Blunt cerebrovascular injury (BCVI) in children after hanging occurs more often than expected. Screening with CT angiography (CTA) may be valuable for early detection and management of this rare but serious condition.
Area of Science:
- Pediatric Trauma Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Blunt cerebrovascular injury (BCVI) incidence in pediatric hanging cases is not well-established.
- Current trauma guidelines suggest screening imaging, but its necessity for asymptomatic pediatric hanging patients is debated.
- BCVI is considered rare after hanging, prompting questions about routine screening.
Purpose of the Study:
- To determine the incidence of BCVI in pediatric hanging incidents.
- To evaluate the diagnostic value of radiographic work-up for BCVI in this population.
Main Methods:
- Retrospective cohort study using the National Trauma Data Bank (2017-2019).
- Included pediatric patients with hanging injuries.
- Analyzed imaging, diagnoses, and clinical indicators (e.g., GCS, cervical/soft tissue injury) for BCVI.
Main Results:
- 179 pediatric patients with signs of life were analyzed.
- BCVI incidence was 5.6% (10 of 179).
- Computed Tomography Angiography (CTA) of the neck was the sole screening modality, performed in 46% of cases.
Conclusions:
- BCVI incidence in pediatric hanging is higher than previously assumed.
- Incomplete CTA reporting may lead to underestimation of BCVI.
- Adding CTA to initial trauma evaluation is recommended to detect cervical vascular injury, pending further outcome studies.
Introduction:
Incidence of blunt cerebrovascular injury (BCVI) following hanging in the pediatric population is ill-defined. Current guidelines recommend screening imaging during the initial trauma evaluation. Necessity of screening is questioned given BCVI is considered rare after hanging, especially when asymptomatic. This study aims to elucidate the incidence of BCVI in pediatric hangings and determine the value of radiographic work-up.
Methods:
A retrospective cohort study was performed of pediatric hangings reported to the National Trauma Data Bank (NTDB), 2017-2019. Imaging, diagnoses, and findings suggestive of BCVI, such as Glasgow Coma Scale (GCS) ≤8, presence of cervical injury, and soft tissue injury were considered. Statistical analysis was carried out to compare incidence.
Results:
197 patients met study criteria, with 179 arriving in the trauma bay with signs of life. BCVI incidence was 5.6% (10 of 179). Computed Tomography Angiography (CTA) of the neck was the only reported screening modality in this data set. A CTA was completed in 46% of the cases.
Discussion:
BCVI incidence following pediatric hanging is more common than previously thought. Less than half of patients had a CTA reported in this cohort. This may result in an underestimate. Given the potentially devastating consequences of a missed BCVI, the addition of CTA to initial work-up may be worthwhile to evaluate for cervical vascular injury, but further studies into the outcomes of children who do receive prophylactic therapy are needed.
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