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Risk factors for blunt cerebrovascular injury in the pediatric patient: A systematic review
Madison Schulz1, Veronica Weihing2, Manish N Shah3
1McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 361-947-1354, USA.
Insights
Pediatric blunt cerebrovascular injury (BCVI) screening requires precise criteria. Cervical spine fractures, skull fractures, and maxillofacial fractures are significant risk factors for BCVI in children.
Area of Science:
- Pediatric Traumatology
- Vascular Surgery
- Radiology
Background:
- Blunt cerebrovascular injury (BCVI) is a rare but serious complication of blunt trauma.
- Accurate diagnosis in pediatric patients is challenging due to unique anatomy and developmental factors.
- Current screening criteria aim to identify BCVI while minimizing radiation exposure in children.
Conclusions:
- Cervical spine fracture, skull fracture, and maxillofacial fractures are key indicators for BCVI in pediatric blunt trauma.
- Depressed GCS score and stroke also correlate with increased BCVI risk.
- Prospective studies are needed to further validate these findings and refine screening guidelines.
Background:
While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population, unique anatomy and development require screening criteria that accurately diagnose these injuries while limiting unwarranted radiation.
Methods:
We searched Medline OVID, EMBASE, and Cochrane Library databases for studies that investigated the risk factors of BCVI in individuals younger than 18 years of age. We adhered to the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the quality of each study using the Newcastle-Ottawa Scale. We compared key characteristics of the papers, including incidence of BCVI, incidence of risk factors, and statistical significance of risk factors.
Results:
Of 1304 studies, 16 met the inclusion criteria. Of these, 15 were retrospective cohort studies and one was a retrospective case control study. Most of the studies included all pediatric blunt trauma admissions, but four only included those which underwent imaging, one only included those with cervical seatbelt sign, and one excluded those who did not survive 24-h post-admission. The ages included as pediatric varied between papers. Papers examined different risk factors and reported differing statistical significances. Though no single risk factor was found to be statistically significant in every study, cervical spine and skull fractures were found to be significant by most. Maxillofacial fractures, depressed GCS score, and stroke were found to be statistically significant by multiple studies. Twelve studies examined cervical soft tissue injury, and none found it to be statistically significant.
Conclusions:
The risk factors most found to be statistically significant for BCVI were cervical spine fracture (10/16 studies), skull fracture (9/16), maxillofacial fractures (7/16), depressed GCS score (5/16), and stroke (5/16). There is a need for prospective studies on this topic.
Level Of Evidence:
Level III, Systematic Review.
