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Screening Pediatric Trauma Patients for Blunt Cerebrovascular Injury Using the McGovern Score: A Retrospective Cohort
Reyna G Osorio1, Adam B Johnson2, Lucas P Neff3
1Departments of Pediatrics.
Insights
The McGovern score improved blunt cerebrovascular injury (BCVI) detection in pediatric trauma patients, showing high sensitivity and specificity. However, its implementation led to increased imaging utilization.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Vascular Imaging
Background:
- Blunt cerebrovascular injury (BCVI) affects ~1% of pediatric blunt trauma patients, carrying significant risks.
- The McGovern score is a pediatric-specific screening tool for BCVI.
Purpose of the Study:
- To evaluate the sensitivity and specificity of the McGovern score for BCVI detection.
- To assess the impact of McGovern score implementation on imaging use and BCVI diagnosis in pediatric trauma.
Main Methods:
- Retrospective cohort study comparing pediatric blunt trauma patients before and after McGovern score implementation.
- Analysis of patient characteristics, imaging studies (CTA/MRA), and outcomes (BCVI, stroke, mortality).
Main Results:
- Post-implementation, imaging for BCVI increased from 2.0% to 5.0% (P=0.003).
- BCVI detection rose from 0.3% to 1.9% (P=0.007).
- In the post-implementation group, McGovern score sensitivity was 90% and specificity was 96.7%.
Conclusions:
- McGovern score implementation increased BCVI detection in pediatric trauma.
- The score demonstrated good sensitivity and specificity.
- A significant increase in imaging use was observed post-implementation.
Background:
Blunt cerebrovascular injury (BCVI), defined as an injury occurring to the carotid and/or vertebral arteries, occurs in ~1% of pediatric blunt trauma patients and is associated with morbidity and mortality. Our objective was to evaluate the sensitivity and specificity of the McGovern score, a pediatric-specific screening tool for BCVI, and describe the effect of its implementation on the use of additional imaging for BCVI and the detection of BCVI.
Methods:
This was a retrospective cohort study of patients below 16 years old presenting with blunt trauma to the Pediatric Emergency Department of a tertiary care level 1 pediatric trauma center pre- (July 1, 2020, to November 30, 2021) and post- (December 1, 2021, to December 31, 2022) implementation of McGovern scoring into the clinical decision algorithm for blunt trauma. Patient characteristics, diagnostic studies used [including computed tomography angiography (CTA) or magnetic resonance angiography (MRA) of the neck vessels], and outcomes (BCVI, stroke, mortality), were obtained from the medical record and compared pre-McGovern versus post-McGovern score implementation.
Results:
A total of 1189 patients were included in the study; 664 p reimplementation of the McGovern scoring and 525 postimplementation. Median age was 6 years (IQR 2 to 11), and 668 (56%) were trauma activations (leveled traumas), with no significant differences in patient characteristics between the 2 cohorts. Imaging for BCVI was performed in 13 (2.0%) patients in the preimplementation group and 27 (5.0%) patients in the postimplementation group ( P =0.003). BCVI was detected in 12/1189 patients overall (1.0%); 2 in the preimplementation group (0.3%), and 10 (1.9%) in the postimplementation group ( P =0.007). In the postimplementation group, the sensitivity of the McGovern score was 90% while the specificity was 96.7%.
Conclusions:
The implementation of the McGovern score into the pediatric trauma decision algorithm was associated with the detection of an increased number of BCVIs compared to the preimplementation group, with good sensitivity and specificity, but a significant increase in the use of imaging.
