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The smallest suffer stroke: Understanding stroke and treatment patterns in children with blunt cerebrovascular injury

Catherine C Dawson-Gore1, Emily K Myers1, Emily H Cooper2

  • 1Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.

Surgery
|April 23, 2025
PubMed

Insights

Pediatric blunt cerebrovascular injury (BCVI) treatment patterns are unclear. Young children with BCVI had higher stroke rates and received less antithrombotic therapy, necessitating treatment guidelines.

Area of Science:

  • Pediatric Traumatology
  • Vascular Neurology
  • Pediatric Critical Care

Background:

  • Blunt cerebrovascular injury (BCVI) in children is uncommon but carries significant risk.
  • Current treatment patterns and stroke rates associated with BCVI in pediatric populations are not well-defined.
  • Optimal timing and use of antithrombotic therapy for pediatric BCVI remain unknown.

Purpose of the Study:

  • To describe stroke rates and treatment patterns in children with blunt cerebrovascular injury.
  • To compare treatment strategies and outcomes across different age groups and injury severities.
  • To identify knowledge gaps regarding antithrombotic therapy in pediatric BCVI.

Main Methods:

  • Retrospective review of the Trauma Quality Improvement Program database (2016-2022).
  • Inclusion of pediatric patients (<18 years) with blunt injury and diagnosed BCVI.
  • Analysis of stroke rates and antithrombotic use, with subgroup analysis excluding traumatic brain injury and contraindications to therapy.

Main Results:

  • A total of 2,336 pediatric BCVI cases (0.34%) were identified among 685,631 blunt injuries.
  • Stroke rates were highest in the youngest children (0-6 years: 6.2%) who received antithrombotic therapy least often.
  • Patients receiving antithrombotic therapy had higher stroke rates (6.1%) compared to untreated patients (2.1%), potentially indicating delayed treatment initiation.

Conclusions:

  • Children aged 0-11 years with BCVI experienced the highest stroke rates and were least likely to receive antithrombotic therapy.
  • Over half of pediatric BCVI patients did not receive antithrombotic therapy.
  • The finding that treated patients had higher stroke rates suggests a need for standardized treatment guidelines to optimize antithrombotic use in pediatric BCVI.
Abstract

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