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The A+ criteria for pediatric blunt cerebrovascular injury: An ATOMAC+ multicenter study
Todd A Nickoles1, James W Eubanks, Ruth A Lewit
1From the Phoenix Children's Hospital (T.A.N., D.M.N., R.L.S.), Phoenix, Arizona; Le Bonheur Children's Hospital (J.W.E., R.A.L., R.S., R.W.); Division of Pediatric Surgery, Department of Surgery (J.W.E., R.A.L., R.W.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (D.M.N.), College of Medicine, University of Arizona; Children's Medical Center (M.R.); Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center, Dallas Texas; Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center; Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences; Dell Medical School (J.A.N.), University of Texas at Austin; and Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas.
Insights
New screening criteria for blunt cerebrovascular injury (BCVI) in children were developed. These criteria identify pediatric trauma patients at high risk for BCVI, improving diagnostic accuracy and limiting radiation exposure.
Area of Science:
- Pediatric Trauma Care
- Cerebrovascular Diagnostics
- Injury Risk Assessment
Background:
- Blunt cerebrovascular injury (BCVI) is a rare but serious condition in children.
- Existing screening criteria for BCVI lack sufficient accuracy in pediatric populations.
- There is a need for improved diagnostic tools to identify at-risk children.
Purpose of the Study:
- To identify common risk factors for BCVI in pediatric trauma patients.
- To derive new, accurate screening criteria for BCVI in children.
- To enhance the diagnostic accuracy of BCVI screening in pediatric trauma.
Main Methods:
- A prospective, multi-institutional observational study of children under 15 with blunt head, face, or neck trauma.
- Patients were screened using the Memphis criteria, with additional data collected on risk factors and examination findings.
- Analysis included 1327 pediatric trauma patients from six level I trauma centers over three years.
Main Results:
- Only 1.09% of enrolled patients (25 out of 2,283) were diagnosed with BCVI.
- Univariate analysis revealed numerous injuries predicting BCVI (p < 0.0001).
- Multivariable analysis identified temporal, sphenoid, orbital roof fractures, C1-4 fractures, and cervical spine ligamentous injuries as significant predictors of BCVI.
Conclusions:
- The developed 'A+ criteria' demonstrate high sensitivity and specificity for BCVI screening in pediatric trauma.
- These criteria effectively identify children at high risk for BCVI.
- Implementation of these criteria can help limit unnecessary radiation exposure in children.
Background:
Blunt cerebrovascular injury (BCVI) is rare but significant among injured children. Current BCVI screening criteria lack adequate diagnostic accuracy for pediatrics. This preplanned secondary analysis identified common risk factors for BCVI among a multicenter cohort of pediatric trauma centers within the ATOMAC+ Pediatric Trauma Research Network (APTRN) and derived a new set of screening criteria.
Methods:
A prospective, multi-institutional observational study of children <15 years old who sustained blunt trauma to the head, face, or neck (AIS > 0) who presented at one of six level I pediatric trauma centers over a 3-year period was conducted. Patients were prospectively screened using the Memphis criteria to determine need for diagnostic imaging. Additional physical and diagnostic examination findings, risk factors, and screening data were also collected for analysis.
Results:
A total of 2,283 patients were enrolled at the six trauma centers and 25 (1.09%) were diagnosed with a BCVI. Patients without two-week follow up were excluded from analysis, leaving 1327 patients for analysis. Many injuries predicted BCVI on univariate analysis in the study population ( p < 0.0001). When examined with a multivariable logistic regression model, temporal fractures, sphenoid fractures, orbital roof fractures, fractures of C1-4, and/or ligamentous injuries of the cervical spine predicted BCVI in pediatric trauma patients with blunt head, face, or neck injuries. These criteria are used to define a set of screening criteria that are specific to pediatrics and practical to implement.
Conclusion:
The A+ criteria for BCVI screening among pediatric trauma patients suggests a high sensitivity and specificity by including significant injuries and symptoms. These predictors of BCVI may be used to identify pediatric blunt trauma patients at high risk for BCVI while limiting radiation exposure to children.
Level Of Evidence:
Diagnostic Tests or Criteria; Level III.
