TY - JOUR
T1 - Blunt cerebrovascular injury in children
T2 - Underreported or underrecognized?: A multicenter atomac study
AU - Azarakhsh, Nima
AU - Grimes, Sandra
AU - Notrica, David M.
AU - Raines, Alexander
AU - Garcia, Nilda M.
AU - Tuggle, David W.
AU - Maxson, Robert Todd
AU - Alder, Adam C.
AU - Recicar, John
AU - Garcia-Filion, Pamela
AU - Greenwell, Cynthia
AU - Lawson, Karla A.
AU - Wan, Jim Y.
AU - Eubanks, James Wallace
PY - 2013/12
Y1 - 2013/12
N2 - 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.
AB - 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.
KW - BCVI
KW - Children
KW - Pediatric
KW - Stroke
KW - Trauma
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U2 - 10.1097/TA.0b013e31829d3526
DO - 10.1097/TA.0b013e31829d3526
M3 - Article
C2 - 24256674
AN - SCOPUS:84890026856
SN - 2163-0755
VL - 75
SP - 1006
EP - 1011
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -