Blunt cerebrovascular injury in children: Underreported or underrecognized?: A multicenter atomac study

Nima Azarakhsh, Sandra Grimes, David M. Notrica, Alexander Raines, Nilda M. Garcia, David W. Tuggle, Robert Todd Maxson, Adam C. Alder, John Recicar, Pamela Garcia-Filion, Cynthia Greenwell, Karla A. Lawson, Jim Y. Wan, James Wallace Eubanks

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

BACKGROUND: Blunt cerebrovascular injury (BCVI) has been well described in the adult trauma literature. The risk factors, proper screening, and treatment options are well known. In pediatric trauma, there has been very little research performed regarding this injury. We hypothesize that the incidence of BCVI in children is lower than the 1% reported incidence in adult studies and that many children at risk are not being screened properly. METHODS: This is a multi-institutional retrospective cohort study of pediatric patients (G15 years) admitted with blunt trauma to six American College of SurgeonsYverified Level 1 pediatric trauma centers between October 2009 and June 2011. All patients with head, neck, or face injuries who were high risk for BCVI based on Memphis criteria were analyzed. RESULTS: Of 5,829 blunt trauma admissions, 538 patients had at least one of the Memphis criteria. Only 89 (16.5%) of these patientswere screened (16 patients had more than one test) by angiography (64 by computed tomography angiography, 39 by magnetic resonance angiography, and 2 by conventional angiography), while 459 (83.5%) were not screened. Screened patients differed from unscreened patients in Injury Severity Score (ISS) (22.6±13.3 vs. 13.3±9.9, p G 0.0001) and head and neck Abbreviated Injury Scale (AIS) score (3.7±1.2 vs. 2.8±1.2, p < 0.0001). The incidence of BCVI in our total population was 0.4% (23 patients). Of the 23 patients with BCVI, 3 (13%) had no risk factors for the injury. The odds of having sustained BCVI in a patient with one or more of the risk factors was 4.0 (95% confidence interval, 1.1-14.2). CONCLUSION: BCVI in Level 1 pediatric trauma centers is diagnosed less frequently than in adult centers. However, screening was performed in a minority of high-risk patients who may explain the reported lower incidence of BCVI in children. Pediatric surgeons need to become more vigilant about screening pediatric patients with high-risk criteria for BCVI.

Original languageEnglish (US)
Pages (from-to)1006-1011
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number6
DOIs
StatePublished - Dec 1 2013

Keywords

  • BCVI
  • Children
  • Pediatric
  • Stroke
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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