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Rossidis AC, Tharakan SJ, Bose SK, et al. Predictors of pediatric blunt cerebrovascular injury. J Pediatr Surg. 2017;doi: 10.1016/j.jpedsurg.2017.10.037.
Rossidis, A. C., Tharakan, S. J., Bose, S. K., Shekdar, K. V., Nance, M. L., & Blinman, T. A. (2017). Predictors of pediatric blunt cerebrovascular injury. Journal of pediatric surgery, . https://doi.org/10.1016/j.jpedsurg.2017.10.037
Rossidis, Avery C, et al. "Predictors of pediatric blunt cerebrovascular injury." Journal of pediatric surgery vol. (2017). doi: https://doi.org/10.1016/j.jpedsurg.2017.10.037
Rossidis AC, Tharakan SJ, Bose SK, Shekdar KV, Nance ML, Blinman TA. Predictors of pediatric blunt cerebrovascular injury. J Pediatr Surg. 2017 Oct 12; doi: 10.1016/j.jpedsurg.2017.10.037. Epub 2017 Oct 12. PMID: 29108846.
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J Pediatr Surg. 2017 Oct 12; doi: 10.1016/j.jpedsurg.2017.10.037. Epub 2017 Oct 12.

Predictors of pediatric blunt cerebrovascular injury.

Journal of pediatric surgery

Avery C Rossidis, Sasha J Tharakan, Sourav K Bose, Karuna V Shekdar, Michael L Nance, Thane A Blinman

Affiliations

  1. Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  3. Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
  4. Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: [email protected].

PMID: 29108846 DOI: 10.1016/j.jpedsurg.2017.10.037

Abstract

BACKGROUND/PURPOSE: Blunt cerebrovascular injury (BCVI) is clinically challenging because these injuries are hard to detect and can have serious neurological consequences, and optimal screening criteria have not been established for children. This study aims to determine risk factors for BCVI in pediatric patients and to evaluate screening practices in a single institutional series.

METHODS: A retrospective review of all pediatric blunt trauma patients evaluated over a 10-year period was performed. Demographic, clinical, and radiographic data were reviewed, including the presence of adult risk factors for BCVI. Logistic regression analyses were performed with statistical significance established at p<0.05.

RESULTS: Of the 11,596 patients evaluated during the study period, 1018 (8.8%) had at least one adult risk factor for BCVI, but only 62 (6.1% of those with risk factors) underwent angiographic evaluation. Overall, 11 BCVIs were observed, resulting in an incidence of 0.095%. All 11 patients with BCVI had at least one risk factor. Multivariate logistic regression analysis identified cervical spine fracture (OR 36.88 [8.36, 169.95]), GCS score ≤ 8 (OR 16.42 [2.16, 102.33]), male gender (OR 10.52 [1.33, 363.30]), Le Fort II or III facial fracture (OR 63.71 [2.16, 1124.68]), and ISS (unit OR 1.10 [1.04, 1.17]) as independent risk factors for BCVI.

CONCLUSION: Adult screening criteria for BCVI appear appropriate for pediatric patients, but most at-risk children are not being screened.

LEVEL OF EVIDENCE: Level III (retrospective case-control study).

Copyright © 2017 Elsevier Inc. All rights reserved.

Keywords: Blunt cerebrovascular injury; Carotid artery injury; Pediatric trauma; Risk factors; Screening criteria; Vertebral artery injury

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